Key result
Novel hemodynamic model identifies ventricular mass, viscoelasticity, and inflow momentum as key drivers of S3.
Why the study?
The proto-diastolic third heart sound (S3) is observed in various hemodynamic conditions, but its generation mechanisms and characteristics under different cardiac states are not fully understood.
A novel hemodynamics-driven mathematical model provides realistic simulation of the third heart sound under various cardiac conditions, which may help identify new indicators for diagnosis and prognosis.
May support noninvasive evaluation of ventricular properties; extends computational modeling of heart sounds but leaves open clinical validation.
The proto-diastolic third heart sound (S3) is observed in various hemodynamic conditions in both normal and diseased hearts. We propose a novel, one-degree of freedom mathematical model of mechanical vibrations of heart and blood that generates the third heart sound, implemented in a real-time model of the cardiovascular system (CircAdapt). To examine model functionality, S3 simulations were performed for conditions mimicking the normal heart as well as heart failure with preserved ejection fraction (HFpEF), atrioventricular valve regurgitation (AVR), atrioventricular valve stenosis (AVS) and septal shunts (SS). Simulated S3 showed both qualitative and quantitative agreements with measured S3 in terms of morphology, frequency, and timing. It was shown that ventricular mass, ventricular viscoelastic properties as well as inflow momentum play a key role in the generation of S3. The model indicated that irrespective of cardiac conditions, S3 vibrations are always generated, in both the left and right sides of the heart, albeit at different levels of audibility. S3 intensities increased in HFpEF, AVR and SS, but the changes of acoustic S3 features in AVS were not significant, as compared with the reference simulation. S3 loudness in all simulated conditions was proportional to the level of cardiac output and severity of cardiac conditions. In conclusion, our hemodynamics-driven mathematical model provides a fast and realistic simulation of S3 under various conditions which may be helpful to find new indicators for diagnosis and prognosis of cardiac diseases.
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Shahmohammadi et al. (2022) studied Third heart sound (S3). Hemodynamics-driven mathematical model vs. Reference simulation was evaluated on S3 acoustic features (morphology, frequency, timing, and loudness). A novel hemodynamics-driven mathematical model successfully simulated the third heart sound, demonstrating that ventricular mass, viscoelastic properties, and inflow momentum are key drivers of S3 generation.
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