Cm. Tribouilloy et al., Pathophysiologic determinants of third heart sounds: A prospective clinical and Doppler echocardiographic study, AM J MED, 111(2), 2001, pp. 96-102
Citations number
43
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
PURPOSE: We sought to determine the importance of a third heart sound (S-3)
and its relation to hemodynamic and valvular dysfunction.
SUBJECTS AND METHODS: We prospectively enrolled 580 patients who had isolat
ed valvular regurgitation (mitral, n = 299; aortic, n = 121) or primary lef
t ventricular dysfunction with or without functional mitral regurgitation (
n = 160). We analyzed the associations between the clinical finding of an a
udible S3 (as noted in routine clinical practice by internal medicine physi
cians) and hemodynamic alterations measured by comprehensive quantitative D
oppler echo cardiography.
RESULTS: S-3 was more prevalent in patients with primary left ventricular d
ysfunction (46%, n = 73) than in organic mitral (16%, n = 47) or aortic (12
%, n = 14) regurgitation (P < 0.001). Patients with an S3 were more likely
to have class III-IV symptoms (55% [74 of 137] vs. 18% [80 of 443] of those
without an S-3, P < 0.001) and had a higher mean [+/- SD] pulmonary pressu
re (55 +/- 15 vs. 41 +/- 11 mm Hg, P < 0.001). An S. was also related to a
higher early filling velocity due to a greater filling volume, restrictive
filling, or both. An S. was a marker of severe regurgitation (regurgitant f
raction greater than or equal to 40%) in patients with primary left ventric
ular dysfunction (odds ratio [OR] = 2.4; 95% confidence interval [CI]: 1.1
to 5.5), mitral regurgitation (OR = 17; 95% CI: 5.8 to 52), and aortic regu
rgitation (OR = 7.1; 95% Cl: 1.8-28). Am S3 was also associated with restri
ctive filling in primary left ventricular dysfunction (OR = 3.0; 95% CI, 1.
6 to 5.9), marked dilatation in mitral regurgitation (OR = 20; 95% CI: 6.8
to 58), and an ejection fraction (< 50%) in aortic regurgitation (OR = 19;
95% CI: 6.0 to 62).
CONCLUSION: An audible S., is an important clinical finding, indicating sev
ere hemodynamic alterations, and should lead to a comprehensive assessment
and consideration of vigorous medical or surgical treatment. (C) 2001 by Ex
cerpta Medica, Inc.