Key result
Ambulatory acoustic cardiography showed S3 was significantly more prevalent in subjects <40 years, whereas S4 was significantly more prevalent and pronounced during sleep in those >40 years.
Observational (n=128)
Ambulatory acoustic cardiography demonstrates that S4 increases nocturnally in older adults reflecting diastolic changes, while S3 is rare after age 40 and may indicate cardiac disease.
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May refine age-specific S3/S4 interpretation during ambulatory monitoring; leaves open prognostic value of nocturnal S4 in older adults.
BACKGROUND: Adequately recording diastolic heart sounds and systolic time intervals over longer periods is difficult. Thus, information on the circadian variation of these parameters in an ambulatory population is lacking. Moreover, age-related changes in the prevalence of diastolic heart sounds and measurements of systolic time intervals in an asymptomatic population have not been studied in continuous recordings. HYPOTHESIS: Diastolic heart sounds and systolic time intervals will have age and circadian variations that reflect known changes in cardiac function due to aging and circadian rhythms. METHODS: We studied 128 asymptomatic subjects wearing an ambulatory monitor with acoustic cardiography. The recording spanned a mean duration of 14 hours, including sleep. Data were analyzed for the presence of third (S3) and fourth (S4) heart sounds and for systolic time intervals. RESULTS: In these asymptomatic subjects, S3 was significantly more prevalent in those age <40 years than in those age >40 years, and significantly more pronounced during sleep in the younger group. Also, S4 was significantly more prevalent in those age >40 years and significantly more pronounced during sleep in those age >40 years. In contrast, time intervals reflecting systolic function showed less circadian variation and less worsening with age. CONCLUSIONS: The nocturnal increase of S4 in the elderly reflects diastolic impairment-likely a result of changes in diastolic filling patterns with increasing age. An S3 after the age of 40 is a relatively uncommon finding and therefore should be a specific sign of cardiac disease. Continuous monitoring of diastolic heart sounds and systolic time intervals is possible using acoustic cardiography.
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Dillier et al. (2011) conducted an observational in Asymptomatic (n=128). Ambulatory monitoring with acoustic cardiography was evaluated on Presence of third (S3) and fourth (S4) heart sounds and systolic time intervals. Ambulatory acoustic cardiography showed S3 was significantly more prevalent in subjects <40 years, whereas S4 was significantly more prevalent and pronounced during sleep in those >40 years.
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