Diastolic heart sounds as an adjunctive diagnostic tool with ST criteria for acute myocardial ischemia

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.

• Heart sounds
• electrocardiography
• phonocardiography
• acoustic cardiography
• myocardial ischemia
• sensitivity
• specificity