Absent fourth heart sound as a marker of adverse events in hypertrophic cardiomyopathy with sinus rhythm

Autor: Chieko Sakai, Tatsuya Kawasaki, Hirofumi Kawamata, Kuniyasu Harimoto, Hirokazu Shiraishi, Satoaki Matoba
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Annals of Noninvasive Electrocardiology, Vol 27, Iss 3, Pp n/a-n/a (2022)
Druh dokumentu: article
ISSN: 1542-474X
1082-720X
DOI: 10.1111/anec.12932
Popis: Abstract Background Patients with hypertrophic cardiomyopathy (HCM) in sinus rhythm commonly show the fourth heart sound (S4). The lack of S4 may be a marker of impaired atrial function in HCM patients with sinus rhythm. Methods and Results This retrospective study consisted of 47 patients with HCM who had undergone phonocardiography and a cardiopulmonary exercise test. The primary outcome was a composite of cardiac death, stroke, hospitalization for worsening heart failure, and newly developed atrial fibrillation (AF). S4 was detected in 38 of 43 patients with sinus rhythm (88%). Peak oxygen consumption was the highest in 38 sinus rhythm patients with S4 (23.6 ± 5.6 mL/kg/min), middle in five sinus rhythm patients without S4 (19.3 ± 6.7 mL/kg/min), and lowest in four patients with AF (15.7 ± 3.3 mL/kg/min, p = 0.01). After a median of 40.5 months, the incidence of the primary outcome was higher in patients without S4 than in those with S4 (33% vs. 8%; hazard ratio, 6.17; 95% confidence interval, 1.02 – 37.4; p = .04) and higher in sinus rhythm patients without S4 than in those with S4 (60% vs. 8%; hazard ratio, 12.05; 95% confidence interval, 2.31 – 71.41; p = .007). Conclusions The absence of S4 on phonocardiography was associated with impaired exercise tolerance and adverse cardiac events in HCM patients with sinus rhythm.
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