Prognostic value of acoustic cardiography in patients with chronic heart failure.
BACKGROUND
Rapid risk stratification in patients with heart failure is critically important but challenging. The aim of our study is to ascertain whether acoustic cardiography can identify heart failure (HF) patients at high risk for mortality.


METHODS
A total of 474 HF patients were enrolled into our study (76±11years old). Acoustic cardiographic parameters included S3 score (ie, third heart sound exists) and systolic dysfunction index (SDI) (correlated closely with left ventricular systolic dysfunction). The event-free survival curves were plotted by Kaplan-Meier method. Cox regression analysis was used to identify independent predictors for all-cause mortality.


RESULTS
During a mean follow-up of 484days, 169 (35.7%) patients died and 126 (26.6%) were due to cardiac causes. After controlling for age, systolic blood pressure, hemoglobin, blood urea nitrogen, albumin, as well as ACEI and beta-blocker treatment in multivariate Cox regression analysis, SDI ≥5 and S3 score ≥4 were both independent predictors for all-cause mortality. Kaplan-Meier analysis showed that HF patients with SDI ≥5 or S3 score ≥4 had a significantly lower survival (52.2% vs. 69.2%, Log-rank χ(2)=18.07, P<0.001; 56.8% vs. 68.6%, Log-rank χ(2)=10.58, P=0.001, respectively) than those with lower SDI or S3 score.


CONCLUSIONS
Acoustic cardiography could serve as a cost-effective and time-efficient tool to identify HF patients at high risk for mortality who might benefit from aggressive monitoring and intervention. It may improve assessment and initial disposition decisions in HF management.
Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China; Department of Cardiology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Shang
S
Wang
Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Ming
M
Liu
Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Fang
F
Fang
Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Qing
Q
Shang
Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Jing Ping
JP
Sun
Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China.
John E
JE
Sanderson
Division of cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Li Ka Shing Institute of Health and Sciences, Institute of Vascular Medicine, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: professorcmyu@gmail.com.
Cheuk Man
CM
Yu
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006326:Heart Auscultation / Q000379:methods; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology*; D006347:Heart Sounds / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D010701:Phonocardiography / Q000379:methods; D011379:Prognosis
Acoustic cardiology; Diagnosis; Heart failure