Controversies exist about the timing relationship between the fourth h
eart sound and the ventricular inflow Doppler events. Besides, there h
as been no data about the timing relationship between the fourth heart
sound and the ventricular outflow Doppler events. This study was desi
gned to measure these phono-Doppler timing relationships and to evalua
te the influence of different Doppler modes on the timing relationship
of the onset of the A wave. Twenty patients (61 +/- 9 years, 18 males
and 2 females) with an audible and recordable fourth heart sound were
included. No matter on the pulsed Doppler wave trace or on the contin
uous-wave trace, both the interval from the onset of the mitral A wave
to the first vibration. of the fourth heart sound and the interval fr
om the peak velocity of the mitral A wave to the first vibration. of t
he fourth heart sound differed significantly from zero (P < 0.001 for
all). Nevertheless, the interval from the onset of the transmitted tra
nsmitral A wave to the first vibration of the fourth heart sound (0.4
+/- 1.7 ms) was not significantly different from zero (P = 0.314). The
pulsed wave data and the continuous wave data were significantly corr
elated. Differences in the Doppler modes do not seem to lead to obviou
s changes in the Doppler-phono timing relationships.