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Published on: September 1, 2014

Correlation of an audible fourth heart sound with level of diastolic dysfunction

David G Meyers1, Innessa T Porter, Kirstie A Schneider

  • 1Division of Cardiovascular Diseases, Department of Internal Medicine, Kansas University School of Medicine, Kansas City, Kansas 66160, USA. dmeyers@kumc.edu

The American Journal of the Medical Sciences
|March 14, 2009
PubMed

Insights

The fourth heart sound (S4) is not a reliable indicator of left ventricular (LV) diastolic dysfunction. Its presence and absence do not consistently correlate with the severity of diastolic dysfunction.

Area of Science:

  • Cardiology
  • Cardiac Physiology

Background:

  • The clinical utility of the fourth heart sound (S4) in diagnosing left ventricular (LV) diastolic dysfunction is debated among experts.
  • Disagreement exists regarding the S4's effectiveness as a marker for LV diastolic dysfunction.

Purpose of the Study:

  • To investigate the correlation between the prevalence of the S4 and the severity of LV diastolic dysfunction.
  • To determine the diagnostic accuracy of the S4 for identifying LV diastolic dysfunction.

Main Methods:

  • A study involving 106 patients in sinus rhythm was conducted, excluding those with specific cardiac conditions.
  • Investigators blinded to diastolic function status auscultated for S4 in participants.
  • Diastolic function was assessed by other cardiologists using mitral inflow, tissue, and pulmonary vein Doppler echocardiography.

Main Results:

  • S4 was detected in 35% with normal function, 42% with mild, and 70% with moderate diastolic dysfunction.
  • Notably, S4 was absent in all patients with severe diastolic dysfunction (P = 0.052).
  • The S4 demonstrated low sensitivity (43%), specificity (65%), and accuracy (53%) for distinguishing normal from abnormal diastolic function.

Conclusions:

  • The S4 is neither sensitive nor specific for diagnosing LV diastolic dysfunction.
  • The S4 sound is common in the elderly with normal function and absent in severe dysfunction, rendering it an unreliable indicator.
Abstract

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