Key result
The third heart sound measured by an implantable cardiac device was superior to auscultation for predicting heart failure events over the whole study (HR 2.9, P<0.0001).
Why the study?
The relationship between S3 measured by an implantable cardiac device and auscultation, as well as their prognostic powers for predicting heart failure events, needed evaluation.
Does continuous ambulatory monitoring of the third heart sound via an implanted device improve the prediction of heart failure events compared to auscultation?
Cohort (n=900)
Does continuous ambulatory monitoring of the third heart sound via an implanted device improve the prediction of heart failure events compared to auscultation?
Hazard Ratio: 2.9
p-value: p=<0.0001
Continuous ambulatory monitoring of the third heart sound via an implanted device provides superior prognostic power for predicting heart failure events compared to standard auscultation.
Device S3 may enhance HF risk stratification beyond auscultation in CRT-D recipients; leaves open whether continuous monitoring improves outcomes.
BACKGROUND: We compared the relationship between the third heart sound (S3) measured by an implantable cardiac device (devS3) and auscultation (ausS3) and evaluated their prognostic powers for predicting heart failure events (HFEs). METHODS AND RESULTS: In the MultiSENSE study, devS3 was measured daily with continuous values, whereas ausS3 was assessed at study visits with discrete grades. They were compared among patients with and without HFEs at baseline and against each other directly. Cox proportional hazard models were developed between follow-up visits and over the whole study. Simulations were performed on devS3 to match the limitations of auscultation. We studied 900 patients, of whom 106 patients experienced 192 HFEs. Two S3 sensing modalities correlated with each other, but at baseline, only devS3 differentiated patients with or without HFEs (P < 0.0001). The prognostic power of devS3 was superior to that of ausS3 both between follow-up visits (HR = 5.7, P < 0.0001, and 1.7, P = 0.047, respectively) and over the whole study (HR = 2.9, P < 0.0001, and 1.4, P = 0.216, respectively). Simulation results suggested this superiority may be attributed to continuous monitoring and to subaudible measuring capability. CONCLUSIONS: S3 measured by implantable cardiac devices has stronger prognostic power to predict episodes of future HFEs than that of auscultation.
No takes yet. Share an insight, caveat, or question.
Cao et al. (2019) conducted a cohort in Heart failure (n=900). Third heart sound measured by an implantable cardiac device (devS3) vs. Auscultation (ausS3) was evaluated on Heart failure events (HFEs) over the whole study (HR 2.9, p=<0.0001). The third heart sound measured by an implantable cardiac device was superior to auscultation for predicting heart failure events over the whole study (HR 2.9, P<0.0001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: