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Andrew D Michaels - One of the best experts on this subject based on the ideXlab platform.
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physiology of the Third Heart Sound novel insights from tissue doppler imaging
Journal of The American Society of Echocardiography, 2008Co-Authors: Sanjiv J Shah, Gregory M Marcus, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background The Third Heart Sound (S 3 ) 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 S 3 . Methods A total of 90 subjects underwent phonocardiography, echocardiography, tissue Doppler imaging, and left-sided Heart catheterization. Results Phonocardiography detected an S 3 in 21 patients (23%). Subjects with an S 3 had lower ejection fraction ( P = .0006) and increased E deceleration rate ( P P P 3 confidence score correlated with E/E' ( r = 0.46; P r = 0.43, P = .0001). Of the echocardiographic variables, only E/E' was independently associated with the S 3 confidence score ( P = .009), independently of invasively determined LV filling pressures ( P = .001). Conclusions The most important determinants of the pathologic S 3 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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hemodynamic correlates of the Third Heart Sound and systolic time intervals
Congestive Heart Failure, 2006Co-Authors: Sanjiv J Shah, Andrew D MichaelsAbstract:Bedside diagnostic tools remain important in the care of patients with Heart failure. Over the past two centuries, cardiac auscultation and phonocardiography have been essential in understanding cardiac pathophysiology and caring for patients with Heart disease. Diastolic Heart Sounds (S3 and S4) and systolic time intervals have been particularly useful in this regard. Unfortunately, auscultation skills have declined considerably, and systolic time intervals have traditionally required carotid pulse tracings. Newer technology allows the automated detection of Heart Sounds and measurement of systolic time intervals in a simple, inexpensive, noninvasive system. Using the newer system, the authors present data on the hemodynamic correlates of the S3 and abnormal systolic time intervals. These data serve as the foundation for using the system to better understand the test characteristics and pathophysiology of the S3 and systolic time intervals, and help to define their use in improving the bedside diagnosis and management of patients with Heart failure.
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background: Poor performance by physicians-intraining and interobserver variability between physicianshavediminishedclinicians’confidenceinthevalue of the Third Heart Sound (S3). Methods:To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience),phonocardiography,measurementofblood B-type natriuretic peptide levels, echocardiography for measurementofleftventricularejectionfraction,andcardiac catheterization for measurement of left ventricular end-diastolic pressure. Results:Whereasresidents’andinterns’auscultatoryfindings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiologyfellows(=0.37;P.001)andcardiologyattendings (=0.29;P=.003)agreedwithphonocardiographicfindings. Although the sensitivities of the S3 were low (13%52%) for identifying patients with abnormal measures of leftventricularfunction,thespecificitieswerehigh(85%95%),withthebesttestcharacteristicsexhibitedbyphonocardiography and more experienced physicians. The S3detectedbyattendingsandfellowswassuperiorindistinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure (P=.002.02forattendingsand.02-.03forfellows)comparedwith residents (P=.02-.47) or interns (P=.09-.64). Conclusions: The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superiorforphonocardiography,theassociationsbetweenthe S3 and abnormal markers of left ventricular functionimproved with each level of auscultator experience. Arch Intern Med. 2006;166:617-622
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background Poor performance by physicians-in-training and interobserver variability between physicians have diminished clinicians' confidence in the value of the Third Heart Sound (S3). Methods To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience), phonocardiography, measurement of blood B-type natriuretic peptide levels, echocardiography for measurement of left ventricular ejection fraction, and cardiac catheterization for measurement of left ventricular end-diastolic pressure. Results Whereas residents' and interns' auscultatory findings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiology fellows (κ = 0.37; P P = .003) agreed with phonocardiographic findings. Although the sensitivities of the S3 were low (13%-52%) for identifying patients with abnormal measures of left ventricular function, the specificities were high (85%-95%), with the best test characteristics exhibited by phonocardiography and more experienced physicians. The S3 detected by attendings and fellows was superior in distinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure ( P = .002-.02 for attendings and .02-.03 for fellows) compared with residents ( P = .02-.47) or interns ( P = .09-.64). Conclusions The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superior for phonocardiography, the associations between the S3 and abnormal markers of left ventricular function improved with each level of auscultator experience.
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usefulness of the Third Heart Sound in predicting an elevated level of b type natriuretic peptide
American Journal of Cardiology, 2004Co-Authors: Gregory M Marcus, Andrew D Michaels, Teresa De Marco, Charles E Mcculloch, Kanu ChatterjeeAbstract:Third Heart Sounds were sought in 100 consecutive outpatients who had B-type natriuretic peptide (BNP) levels measured within 8 hours. Mean BNP levels were significantly higher in those with a Third Heart Sound. The presence of a Third Heart Sound was 41% sensitive and 97% specific for elevated BNP levels.
Kanu Chatterjee - One of the best experts on this subject based on the ideXlab platform.
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physiology of the Third Heart Sound novel insights from tissue doppler imaging
Journal of The American Society of Echocardiography, 2008Co-Authors: Sanjiv J Shah, Gregory M Marcus, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background The Third Heart Sound (S 3 ) 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 S 3 . Methods A total of 90 subjects underwent phonocardiography, echocardiography, tissue Doppler imaging, and left-sided Heart catheterization. Results Phonocardiography detected an S 3 in 21 patients (23%). Subjects with an S 3 had lower ejection fraction ( P = .0006) and increased E deceleration rate ( P P P 3 confidence score correlated with E/E' ( r = 0.46; P r = 0.43, P = .0001). Of the echocardiographic variables, only E/E' was independently associated with the S 3 confidence score ( P = .009), independently of invasively determined LV filling pressures ( P = .001). Conclusions The most important determinants of the pathologic S 3 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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diagnostic characteristics of combining phonocardiographic Third Heart Sound and systolic time intervals for the prediction of left ventricular dysfunction
Journal of Cardiac Failure, 2007Co-Authors: Mia Shapiro, Gregory M Marcus, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Brian Moyers, Kanu ChatterjeeAbstract:Abstract Background The Third Heart Sound (S3) and systolic time intervals (STIs) are validated clinical indicators of left ventricular (LV) dysfunction. We investigated the test characteristics of a combined score summarizing S3 and STI results for predicting LV dysfunction. Methods and Results A total of 81 adults underwent computerized phonelectrocardiography for S3 and STI (Audicor, Inovise Medical Inc), cardiac catheterization for LV end-diastolic pressure (LVEDP), echocardiography for LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. LV dysfunction was defined as both an LVEDP >15 mm Hg and LVEF P = .0003), −0.53 for LVEF ( P P = .0008). This index had a receiver operative curve c-statistic of 0.89 for diagnosis of LV dysfunction; a cutoff >1.87 yielded 72% sensitivity, 92% specificity, 9.0 positive likelihood ratio, and 88% accuracy. Conclusions In this preliminary study, the LV dysfunction index combined S3 and STI data from noninvasive electrophonocardiography, and yielded superior test characteristics compared to the individual tests for the diagnosis of LV dysfunction.
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clinical investigations diagnostic characteristics of combining phonocardiographic Third Heart Sound and systolic time intervals for the prediction of left ventricular dysfunction
2007Co-Authors: Mia Shapiro, Gregory M Marcus, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Brian Moyers, Kanu ChatterjeeAbstract:Background: The Third Heart Sound (S3) and systolic time intervals (STIs) are validated clinical indicators of left ventricular (LV) dysfunction. We investigated the test characteristics of a combined score summarizing S3 and STI results for predicting LV dysfunction. Methods and Results: A total of 81 adults underwent computerized phonelectrocardiography for S3 and STI (Audicor, Inovise Medical Inc), cardiac catheterization for LVend-diastolic pressure (LVEDP), echocardiography for LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. LV dysfunction was defined as both an LVEDP O15 mm Hg and LVEF !50%. The STI measured was the electromechanical activation time (EMAT) divided by LV systolic time (LVST). Z-scores for the S3 confidence score and EMAT/LVST were summed to generate the LV dysfunction index. The LV dysfunction index had a correlation coefficient of 0.38 for LVEDP (P 5 .0003), � 0.53 for LVEF (P ! .0001), and 0.35 for BNP (P 5 .0008). This index had a receiver operative curve c-statistic of 0.89 for diagnosis of LV dysfunction; a cutoff O1.87 yielded 72% sensitivity, 92% specificity, 9.0 positive likelihood ratio, and 88% accuracy. Conclusions: In this preliminary study, the LV dysfunction index combined S3 and STI data from noninvasive electrophonocardiography, and yielded superior test characteristics compared to the individual tests for the diagnosis of LV dysfunction. (J Cardiac Fail 2007;13:18e24)
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background: Poor performance by physicians-intraining and interobserver variability between physicianshavediminishedclinicians’confidenceinthevalue of the Third Heart Sound (S3). Methods:To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience),phonocardiography,measurementofblood B-type natriuretic peptide levels, echocardiography for measurementofleftventricularejectionfraction,andcardiac catheterization for measurement of left ventricular end-diastolic pressure. Results:Whereasresidents’andinterns’auscultatoryfindings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiologyfellows(=0.37;P.001)andcardiologyattendings (=0.29;P=.003)agreedwithphonocardiographicfindings. Although the sensitivities of the S3 were low (13%52%) for identifying patients with abnormal measures of leftventricularfunction,thespecificitieswerehigh(85%95%),withthebesttestcharacteristicsexhibitedbyphonocardiography and more experienced physicians. The S3detectedbyattendingsandfellowswassuperiorindistinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure (P=.002.02forattendingsand.02-.03forfellows)comparedwith residents (P=.02-.47) or interns (P=.09-.64). Conclusions: The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superiorforphonocardiography,theassociationsbetweenthe S3 and abnormal markers of left ventricular functionimproved with each level of auscultator experience. Arch Intern Med. 2006;166:617-622
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background Poor performance by physicians-in-training and interobserver variability between physicians have diminished clinicians' confidence in the value of the Third Heart Sound (S3). Methods To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience), phonocardiography, measurement of blood B-type natriuretic peptide levels, echocardiography for measurement of left ventricular ejection fraction, and cardiac catheterization for measurement of left ventricular end-diastolic pressure. Results Whereas residents' and interns' auscultatory findings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiology fellows (κ = 0.37; P P = .003) agreed with phonocardiographic findings. Although the sensitivities of the S3 were low (13%-52%) for identifying patients with abnormal measures of left ventricular function, the specificities were high (85%-95%), with the best test characteristics exhibited by phonocardiography and more experienced physicians. The S3 detected by attendings and fellows was superior in distinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure ( P = .002-.02 for attendings and .02-.03 for fellows) compared with residents ( P = .02-.47) or interns ( P = .09-.64). Conclusions The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superior for phonocardiography, the associations between the S3 and abnormal markers of left ventricular function improved with each level of auscultator experience.
Gregory M Marcus - One of the best experts on this subject based on the ideXlab platform.
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physiology of the Third Heart Sound novel insights from tissue doppler imaging
Journal of The American Society of Echocardiography, 2008Co-Authors: Sanjiv J Shah, Gregory M Marcus, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background The Third Heart Sound (S 3 ) 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 S 3 . Methods A total of 90 subjects underwent phonocardiography, echocardiography, tissue Doppler imaging, and left-sided Heart catheterization. Results Phonocardiography detected an S 3 in 21 patients (23%). Subjects with an S 3 had lower ejection fraction ( P = .0006) and increased E deceleration rate ( P P P 3 confidence score correlated with E/E' ( r = 0.46; P r = 0.43, P = .0001). Of the echocardiographic variables, only E/E' was independently associated with the S 3 confidence score ( P = .009), independently of invasively determined LV filling pressures ( P = .001). Conclusions The most important determinants of the pathologic S 3 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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diagnostic characteristics of combining phonocardiographic Third Heart Sound and systolic time intervals for the prediction of left ventricular dysfunction
Journal of Cardiac Failure, 2007Co-Authors: Mia Shapiro, Gregory M Marcus, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Brian Moyers, Kanu ChatterjeeAbstract:Abstract Background The Third Heart Sound (S3) and systolic time intervals (STIs) are validated clinical indicators of left ventricular (LV) dysfunction. We investigated the test characteristics of a combined score summarizing S3 and STI results for predicting LV dysfunction. Methods and Results A total of 81 adults underwent computerized phonelectrocardiography for S3 and STI (Audicor, Inovise Medical Inc), cardiac catheterization for LV end-diastolic pressure (LVEDP), echocardiography for LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. LV dysfunction was defined as both an LVEDP >15 mm Hg and LVEF P = .0003), −0.53 for LVEF ( P P = .0008). This index had a receiver operative curve c-statistic of 0.89 for diagnosis of LV dysfunction; a cutoff >1.87 yielded 72% sensitivity, 92% specificity, 9.0 positive likelihood ratio, and 88% accuracy. Conclusions In this preliminary study, the LV dysfunction index combined S3 and STI data from noninvasive electrophonocardiography, and yielded superior test characteristics compared to the individual tests for the diagnosis of LV dysfunction.
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clinical investigations diagnostic characteristics of combining phonocardiographic Third Heart Sound and systolic time intervals for the prediction of left ventricular dysfunction
2007Co-Authors: Mia Shapiro, Gregory M Marcus, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Brian Moyers, Kanu ChatterjeeAbstract:Background: The Third Heart Sound (S3) and systolic time intervals (STIs) are validated clinical indicators of left ventricular (LV) dysfunction. We investigated the test characteristics of a combined score summarizing S3 and STI results for predicting LV dysfunction. Methods and Results: A total of 81 adults underwent computerized phonelectrocardiography for S3 and STI (Audicor, Inovise Medical Inc), cardiac catheterization for LVend-diastolic pressure (LVEDP), echocardiography for LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. LV dysfunction was defined as both an LVEDP O15 mm Hg and LVEF !50%. The STI measured was the electromechanical activation time (EMAT) divided by LV systolic time (LVST). Z-scores for the S3 confidence score and EMAT/LVST were summed to generate the LV dysfunction index. The LV dysfunction index had a correlation coefficient of 0.38 for LVEDP (P 5 .0003), � 0.53 for LVEF (P ! .0001), and 0.35 for BNP (P 5 .0008). This index had a receiver operative curve c-statistic of 0.89 for diagnosis of LV dysfunction; a cutoff O1.87 yielded 72% sensitivity, 92% specificity, 9.0 positive likelihood ratio, and 88% accuracy. Conclusions: In this preliminary study, the LV dysfunction index combined S3 and STI data from noninvasive electrophonocardiography, and yielded superior test characteristics compared to the individual tests for the diagnosis of LV dysfunction. (J Cardiac Fail 2007;13:18e24)
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background: Poor performance by physicians-intraining and interobserver variability between physicianshavediminishedclinicians’confidenceinthevalue of the Third Heart Sound (S3). Methods:To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience),phonocardiography,measurementofblood B-type natriuretic peptide levels, echocardiography for measurementofleftventricularejectionfraction,andcardiac catheterization for measurement of left ventricular end-diastolic pressure. Results:Whereasresidents’andinterns’auscultatoryfindings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiologyfellows(=0.37;P.001)andcardiologyattendings (=0.29;P=.003)agreedwithphonocardiographicfindings. Although the sensitivities of the S3 were low (13%52%) for identifying patients with abnormal measures of leftventricularfunction,thespecificitieswerehigh(85%95%),withthebesttestcharacteristicsexhibitedbyphonocardiography and more experienced physicians. The S3detectedbyattendingsandfellowswassuperiorindistinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure (P=.002.02forattendingsand.02-.03forfellows)comparedwith residents (P=.02-.47) or interns (P=.09-.64). Conclusions: The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superiorforphonocardiography,theassociationsbetweenthe S3 and abnormal markers of left ventricular functionimproved with each level of auscultator experience. Arch Intern Med. 2006;166:617-622
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background Poor performance by physicians-in-training and interobserver variability between physicians have diminished clinicians' confidence in the value of the Third Heart Sound (S3). Methods To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience), phonocardiography, measurement of blood B-type natriuretic peptide levels, echocardiography for measurement of left ventricular ejection fraction, and cardiac catheterization for measurement of left ventricular end-diastolic pressure. Results Whereas residents' and interns' auscultatory findings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiology fellows (κ = 0.37; P P = .003) agreed with phonocardiographic findings. Although the sensitivities of the S3 were low (13%-52%) for identifying patients with abnormal measures of left ventricular function, the specificities were high (85%-95%), with the best test characteristics exhibited by phonocardiography and more experienced physicians. The S3 detected by attendings and fellows was superior in distinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure ( P = .002-.02 for attendings and .02-.03 for fellows) compared with residents ( P = .02-.47) or interns ( P = .09-.64). Conclusions The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superior for phonocardiography, the associations between the S3 and abnormal markers of left ventricular function improved with each level of auscultator experience.
Daniel L Dries - One of the best experts on this subject based on the ideXlab platform.
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Third Heart Sound and elevated jugular venous pressure as markers of the subsequent development of Heart failure in patients with asymptomatic left ventricular dysfunction
The American Journal of Medicine, 2003Co-Authors: Mark H Drazner, Eduardo J Rame, Daniel L DriesAbstract:Abstract Purpose To determine the independent prognostic value of a Third Heart Sound (S 3 ) and elevated jugular venous pressure in patients with asymptomatic left ventricular dysfunction. Methods We performed a post hoc analysis of 4102 participants from the Studies of Left Ventricular Dysfunction (SOLVD) prevention trial. In that trial, participants with asymptomatic or minimally symptomatic left ventricular dysfunction (New York Association class I or II, left ventricular ejection fraction ≤0.35, no treatment for Heart failure) were allocated randomly to enalapril or placebo and followed for a mean (± SD) of 34 ± 14 months. The presence of an S 3 and elevated jugular venous pressure was ascertained by physical examination at study enrollment. We used multivariate proportional hazards models to determine whether these physical examination findings were associated with the development of Heart failure, a prespecified endpoint of the SOLVD prevention trial. Results At baseline, 209 subjects (5.1%) had an S 3 and 70 (1.7%) had elevated jugular venous pressure. Heart failure developed in 1044 subjects (25.5%). After adjusting for other markers of disease severity, an S 3 was associated with an increased risk of Heart failure (relative risk [RR] = 1.38; 95% confidence interval [CI]: 1.09 to 1.73; P = 0.007) and the composite endpoint of death or development of Heart failure (RR = 1.34; 95% CI: 1.09 to 1.64; P = 0.005). Elevated jugular venous pressure was also associated with these outcomes in multivariate models. Conclusion The physical examination provides prognostic information among patients with asymptomatic or minimally symptomatic left ventricular dysfunction.
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prognostic importance of elevated jugular venous pressure and a Third Heart Sound in patients with Heart failure
The New England Journal of Medicine, 2001Co-Authors: Mark H Drazner, Eduardo J Rame, Lynne W Stevenson, Daniel L DriesAbstract:Background The independent prognostic value of elevated jugular venous pressure or a Third Heart Sound in patients with Heart failure is not well established. Methods We performed a retrospective analysis of the Studies of Left Ventricular Dysfunction treatment trial, in which 2569 patients with symptomatic Heart failure or a history of it were randomly assigned to receive enalapril or placebo. The mean (±SD) follow-up was 32±15 months. The presence of elevated jugular venous pressure or a Third Heart Sound was ascertained by physical examination on entry into the trial. The risks of hospitalization for Heart failure and progression of Heart failure as defined by death from pump failure and the composite end point of death or hospitalization for Heart failure were compared in patients with these findings on physical examination and patients without these findings. Results In multivariate analyses that were adjusted for other markers of the severity of Heart failure, elevated jugular venous pressure was as...
Joshua C Vessey - One of the best experts on this subject based on the ideXlab platform.
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physiology of the Third Heart Sound novel insights from tissue doppler imaging
Journal of The American Society of Echocardiography, 2008Co-Authors: Sanjiv J Shah, Gregory M Marcus, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background The Third Heart Sound (S 3 ) 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 S 3 . Methods A total of 90 subjects underwent phonocardiography, echocardiography, tissue Doppler imaging, and left-sided Heart catheterization. Results Phonocardiography detected an S 3 in 21 patients (23%). Subjects with an S 3 had lower ejection fraction ( P = .0006) and increased E deceleration rate ( P P P 3 confidence score correlated with E/E' ( r = 0.46; P r = 0.43, P = .0001). Of the echocardiographic variables, only E/E' was independently associated with the S 3 confidence score ( P = .009), independently of invasively determined LV filling pressures ( P = .001). Conclusions The most important determinants of the pathologic S 3 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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diagnostic characteristics of combining phonocardiographic Third Heart Sound and systolic time intervals for the prediction of left ventricular dysfunction
Journal of Cardiac Failure, 2007Co-Authors: Mia Shapiro, Gregory M Marcus, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Brian Moyers, Kanu ChatterjeeAbstract:Abstract Background The Third Heart Sound (S3) and systolic time intervals (STIs) are validated clinical indicators of left ventricular (LV) dysfunction. We investigated the test characteristics of a combined score summarizing S3 and STI results for predicting LV dysfunction. Methods and Results A total of 81 adults underwent computerized phonelectrocardiography for S3 and STI (Audicor, Inovise Medical Inc), cardiac catheterization for LV end-diastolic pressure (LVEDP), echocardiography for LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. LV dysfunction was defined as both an LVEDP >15 mm Hg and LVEF P = .0003), −0.53 for LVEF ( P P = .0008). This index had a receiver operative curve c-statistic of 0.89 for diagnosis of LV dysfunction; a cutoff >1.87 yielded 72% sensitivity, 92% specificity, 9.0 positive likelihood ratio, and 88% accuracy. Conclusions In this preliminary study, the LV dysfunction index combined S3 and STI data from noninvasive electrophonocardiography, and yielded superior test characteristics compared to the individual tests for the diagnosis of LV dysfunction.
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clinical investigations diagnostic characteristics of combining phonocardiographic Third Heart Sound and systolic time intervals for the prediction of left ventricular dysfunction
2007Co-Authors: Mia Shapiro, Gregory M Marcus, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Brian Moyers, Kanu ChatterjeeAbstract:Background: The Third Heart Sound (S3) and systolic time intervals (STIs) are validated clinical indicators of left ventricular (LV) dysfunction. We investigated the test characteristics of a combined score summarizing S3 and STI results for predicting LV dysfunction. Methods and Results: A total of 81 adults underwent computerized phonelectrocardiography for S3 and STI (Audicor, Inovise Medical Inc), cardiac catheterization for LVend-diastolic pressure (LVEDP), echocardiography for LV ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. LV dysfunction was defined as both an LVEDP O15 mm Hg and LVEF !50%. The STI measured was the electromechanical activation time (EMAT) divided by LV systolic time (LVST). Z-scores for the S3 confidence score and EMAT/LVST were summed to generate the LV dysfunction index. The LV dysfunction index had a correlation coefficient of 0.38 for LVEDP (P 5 .0003), � 0.53 for LVEF (P ! .0001), and 0.35 for BNP (P 5 .0008). This index had a receiver operative curve c-statistic of 0.89 for diagnosis of LV dysfunction; a cutoff O1.87 yielded 72% sensitivity, 92% specificity, 9.0 positive likelihood ratio, and 88% accuracy. Conclusions: In this preliminary study, the LV dysfunction index combined S3 and STI data from noninvasive electrophonocardiography, and yielded superior test characteristics compared to the individual tests for the diagnosis of LV dysfunction. (J Cardiac Fail 2007;13:18e24)
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background: Poor performance by physicians-intraining and interobserver variability between physicianshavediminishedclinicians’confidenceinthevalue of the Third Heart Sound (S3). Methods:To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience),phonocardiography,measurementofblood B-type natriuretic peptide levels, echocardiography for measurementofleftventricularejectionfraction,andcardiac catheterization for measurement of left ventricular end-diastolic pressure. Results:Whereasresidents’andinterns’auscultatoryfindings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiologyfellows(=0.37;P.001)andcardiologyattendings (=0.29;P=.003)agreedwithphonocardiographicfindings. Although the sensitivities of the S3 were low (13%52%) for identifying patients with abnormal measures of leftventricularfunction,thespecificitieswerehigh(85%95%),withthebesttestcharacteristicsexhibitedbyphonocardiography and more experienced physicians. The S3detectedbyattendingsandfellowswassuperiorindistinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure (P=.002.02forattendingsand.02-.03forfellows)comparedwith residents (P=.02-.47) or interns (P=.09-.64). Conclusions: The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superiorforphonocardiography,theassociationsbetweenthe S3 and abnormal markers of left ventricular functionimproved with each level of auscultator experience. Arch Intern Med. 2006;166:617-622
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relationship between accurate auscultation of a clinically useful Third Heart Sound and level of experience
JAMA Internal Medicine, 2006Co-Authors: Gregory M Marcus, Charles E Mcculloch, Kanu Chatterjee, Ivor L Gerber, Barry H Mckeown, Joshua C Vessey, Mark V Jordan, Michele Huddleston, Elyse Foster, Andrew D MichaelsAbstract:Background Poor performance by physicians-in-training and interobserver variability between physicians have diminished clinicians' confidence in the value of the Third Heart Sound (S3). Methods To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided Heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience), phonocardiography, measurement of blood B-type natriuretic peptide levels, echocardiography for measurement of left ventricular ejection fraction, and cardiac catheterization for measurement of left ventricular end-diastolic pressure. Results Whereas residents' and interns' auscultatory findings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiology fellows (κ = 0.37; P P = .003) agreed with phonocardiographic findings. Although the sensitivities of the S3 were low (13%-52%) for identifying patients with abnormal measures of left ventricular function, the specificities were high (85%-95%), with the best test characteristics exhibited by phonocardiography and more experienced physicians. The S3 detected by attendings and fellows was superior in distinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure ( P = .002-.02 for attendings and .02-.03 for fellows) compared with residents ( P = .02-.47) or interns ( P = .09-.64). Conclusions The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superior for phonocardiography, the associations between the S3 and abnormal markers of left ventricular function improved with each level of auscultator experience.
