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Phono-Doppler Timing Relationships in Patients with a Fourth Heart Sound
Wel-Chol Voon1, Sheng-Hsiung Sheu
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical College, No. 100, Shih-Chuan 1st Road, Koahsiung City 807, Taiwan wcvoonnn@ms2.hinet.net
Insights
This study clarifies the timing between the fourth heart sound and Doppler events, finding significant intervals but no major differences across Doppler modes. These findings aid in understanding cardiac mechanics and diagnosing heart conditions.
Area of Science:
- Cardiology
- Biomedical Engineering
- Echocardiography
Background:
- The precise timing relationship between the fourth heart sound and ventricular inflow/outflow Doppler events remains debated.
- Limited data exists on the timing between the fourth heart sound and ventricular outflow Doppler events.
Purpose of the Study:
- To measure the timing relationships between the fourth heart sound and ventricular inflow/outflow Doppler events.
- To evaluate the impact of different Doppler modes on the timing of the fourth heart sound relative to the mitral A wave onset.
Main Methods:
- Twenty patients with audible and recordable fourth heart sound were enrolled.
- Phono-Doppler techniques were used to measure intervals from mitral A wave onset and peak velocity to the fourth heart sound.
- Both pulsed-wave and continuous-wave Doppler modes were utilized.
Main Results:
- Significant intervals were observed between mitral A wave events (onset and peak) and the first vibration of the fourth heart sound (P < 0.001).
- The interval from the onset of the transmitted transmitral A wave to the fourth heart sound was not significantly different from zero (P = 0.314).
- Pulsed-wave and continuous-wave Doppler data showed significant correlation, indicating minimal influence of Doppler mode on timing relationships.
Conclusions:
- The study establishes measurable timing relationships between the fourth heart sound and Doppler-derived mitral A wave events.
- Doppler mode differences do not significantly alter the observed phono-Doppler timing relationships.
- Findings contribute to a better understanding of cardiac acoustics and hemodynamics.
Abstract:
Controversies exist about the timing relationship between the fourth heart sound and the ventricular inflow Doppler events. Besides, there has been no data about the timing relationship between the fourth heart sound and the ventricular outflow Doppler events. This study was designed to measure these phono-Doppler timing relationships and to evaluate the influence of different Doppler modes on the timing relationship of the onset of the A wave. Twenty patients (61 +/- 9 years, 18 males and 2 females) with an audible and recordable fourth heart sound were included. No matter on the pulsed Doppler wave trace or on the continuous-wave trace, both the interval from the onset of the mitral A wave to the first vibration of the fourth heart sound and the interval from the peak velocity of the mitral A wave to the first vibration of the fourth heart sound differed significantly from zero (P < 0.001 for all). Nevertheless, the interval from the onset of the transmitted transmitral A wave to the first vibration of the fourth heart sound (0.4 +/- 1.7 ms) was not significantly different from zero (P = 0.314). The pulsed wave data and the continuous wave data were significantly correlated. Differences in the Doppler modes do not seem to lead to obvious changes in the Doppler-phono timing relationships.