title: Diastolic heart sounds as an adjunctive diagnostic tool with ST criteria for acute myocardial ischemia.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  The use of computerized acoustic cardiography to detect an S3 or S4 may augment the ECG detection of ischemia.
authors.affiliation: Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA 94143-0610, USA. eunylee@gmail.com
authors.forename: Eunyoung
authors.initials: E
authors.lastname: Lee
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Drew
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Selvester
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Michaels
mesh_terms: D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003971:Diastole; D042241:Early Diagnosis; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006347:Heart Sounds; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D017202:Myocardial Ischemia / Q000175:diagnosis*; D010701:Phonocardiography / Q000379:methods*; D011446:Prospective Studies; D012495:San Francisco; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D012984:Software