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Dynamic Changes in Fourth Heart Sound in Type 2 Diabetes: Insights From Visualized Phonocardiography and SGLT2
Kunimasa Yagi1, Daisuke Chujo2, Shimpei Ogawa3
1Department of Internal Medicine, Kanazawa Medical University Hospital, Kanazawa, Ishikawa 920-0293, Japan.
Case Reports in Medicine
|August 20, 2025
Summary
The fourth heart sound (S4) can indicate left ventricular diastolic dysfunction. Adjusting sodium-glucose co-transporter-2 inhibitor (SGLT2i) therapy dynamically altered S4, suggesting its use in monitoring treatment effectiveness for type 2 diabetes patients.
Area of Science:
- Cardiology
- Endocrinology
- Pharmacology
Background:
- The fourth heart sound (S4) is a key indicator of left ventricular diastolic dysfunction (LVDD).
- Atrial function, often impaired in Type 2 Diabetes (T2D), influences S4 intensity.
- Sodium-glucose co-transporter-2 inhibitors (SGLT2i) can improve atrial function in T2D.
Observation:
- An 83-year-old male with T2D and LVDD experienced a pronounced S4 after discontinuing SGLT2i therapy.
- The S4 correlated with chest discomfort and leg edema, symptoms that improved upon SGLT2i resumption.
- Visual phonocardiography confirmed dynamic changes in S4 intensity with SGLT2i therapy modification.
Findings:
- Discontinuation of SGLT2i therapy led to the reappearance of a significant S4.
- Resuming SGLT2i therapy resulted in a marked reduction of S4 and alleviation of cardiac symptoms.
- Dynamic S4 changes reflect alterations in cardiac function related to SGLT2i therapy.
Implications:
- Dynamic S4 monitoring may serve as a noninvasive tool for adjusting SGLT2i therapy in T2D patients.
- S4 changes can provide real-time feedback on the efficacy of SGLT2i treatment.
- This highlights a novel application of S4 in managing heart failure risk in T2D.
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