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  • Title: Diastolic heart sounds as an adjunctive diagnostic tool with ST criteria for acute myocardial ischemia.
    Author: Lee E, Drew BJ, Selvester RH, Michaels AD.
    Journal: Acute Card Care; 2009; 11(4):229-35. PubMed ID: 19995262.
    Abstract:
    AIMS/METHODS: To investigate whether diastolic third or fourth heart sounds (S3 or S4) detect myocardial ischemia independently or in combination with the 12-lead electrocardiogram (ECG), a prospective comparison study was conducted in a group with ischemia induced by percutaneous coronary intervention (n=19) and a non-ischemia group (n=18) without coronary artery disease or ischemic ECG evidence. Diastolic heart sounds were detected by computerized acoustic cardiography. RESULTS: Of 37 patients, the mean age was 59.4+/-11.8 years. An S4 was more sensitive (74%) in detecting ischemia than an S3 (47%) or standard ST-T criteria (53%). All subjects with standard ST-T wave criteria for PCI-induced ischemia had an S3 or S4. All subjects without an S3 or S4 did not have ST-T wave criteria for ischemia. Using logistic regression, both an S3 and S4 were shown to detect ischemia (P<0.05), independent of ST-T criteria. The detection of ischemia was improved by 32% when the presence of an S3 or S4 was added to ST-T wave criteria. The absence of an S3 and S4 was helpful to rule out myocardial ischemia. CONCLUSION: The use of computerized acoustic cardiography to detect an S3 or S4 may augment the ECG detection of ischemia.
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