Abstract
Reports have suggested that the interval between P wave onset and the fourth heart sound (P-S4 interval) reflects changes in left ventricular myocardial stiffness. We made simultaneous measurements of the P-S4 or atrial electrogram to S4 (A-S4) interval and left ventricular pressure in 19 patients with coronary artery disease who were studied before and after atrial pacing. Thirteen patients developed angina accompanied by significant rises in their end-diastolic pressure and a consistent decrease in P-S4 or A-S4 interval; whereas the six patients who had atrial pacing without the development of angina had no change in end-diastolic pressure, P-S4, or A-S4 interval. The resting data showed in inverse correlation between left ventricular end-diastolic pressure and the P-S4 interval. In addition, the P-S4 interval let us discriminate between patients with normal and abnormal end-diastolic pressure (greater than 15 mmHg).
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- Barry W. H., Brooker J. Z., Alderman E. L., Harrison D. C. Changes in diastolic stiffness and tone of the left ventricle during angina pectoris. Circulation. 1974 Feb;49(2):255–263. doi: 10.1161/01.cir.49.2.255. [DOI] [PubMed] [Google Scholar]
- Benchimol A., Desser K. B. The fourth heart sound in patients without demonstrable heart disease. Am Heart J. 1977 Mar;93(3):298–301. doi: 10.1016/s0002-8703(77)80247-0. [DOI] [PubMed] [Google Scholar]
- Craige E. Gallop rhythm. Prog Cardiovasc Dis. 1967 Nov;10(3):246–261. doi: 10.1016/0033-0620(67)90012-6. [DOI] [PubMed] [Google Scholar]
- Fowler N. O., Adolph R. J. Forth sound gallop or split first sound? Am J Cardiol. 1972 Sep;30(4):441–444. doi: 10.1016/0002-9149(72)90580-2. [DOI] [PubMed] [Google Scholar]
- Gibson T. C., Madry R., Grossman W., McLaurin L. P., Craige E. The A wave of the apexcardiogram and left ventricular diastolic stiffness. Circulation. 1974 Mar;49(3):441–446. doi: 10.1161/01.cir.49.3.441. [DOI] [PubMed] [Google Scholar]
- Hill J. C., O'Rourke R. A., Lewis R. P., Mcgranahan G. M. The diagnostic value of the atrial gallop in acute myocardial infarction. Am Heart J. 1969 Aug;78(2):194–201. doi: 10.1016/0002-8703(69)90008-8. [DOI] [PubMed] [Google Scholar]
- KINCAID-SMITH P., BARLOW J. The atrial sound in hypertension and ischemic heart disease, with reference to its timing and mode of production. Br Heart J. 1959 Oct;21:479–491. doi: 10.1136/hrt.21.4.479. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mann T., Brodie B. R., Grossman W., McLaurin L. P. Effect of angina on the left ventricular diastolic pressure-volume relationship. Circulation. 1977 May;55(5):761–766. doi: 10.1161/01.cir.55.5.761. [DOI] [PubMed] [Google Scholar]
- McLaurin L. P., Rolett E. L., Grossman W. Impaired left ventricular relaxation during pacing-induced ischemia. Am J Cardiol. 1973 Nov;32(6):751–757. doi: 10.1016/s0002-9149(73)80002-5. [DOI] [PubMed] [Google Scholar]
- Mirsky I., Cohn P. F., Levine J. A., Gorlin R., Herman M. V., Kreulen T. H., Sonnenblick E. H. Assessment of left ventricular stiffness in primary myocardial disease and coronary artery disease. Circulation. 1974 Jul;50(1):128–136. doi: 10.1161/01.cir.50.1.128. [DOI] [PubMed] [Google Scholar]
- O'Rourke R. A. The atrial sound. Factors regulating its occurrence and timing. Am Heart J. 1970 Nov;80(5):715–716. doi: 10.1016/0002-8703(70)90020-7. [DOI] [PubMed] [Google Scholar]
- Shah P. M., Gramiak R., Kramer D. H., Yu P. N. Determinants of atrial (S4) and ventricular (S3) gallop sounds in primary myocardial disease. N Engl J Med. 1968 Apr 4;278(14):753–758. doi: 10.1056/NEJM196804042781402. [DOI] [PubMed] [Google Scholar]
- Spodick D. H., Quarry V. M. Prevalence of the fourth heart sound by phonocardiography in the absence of cardiac disease. Am Heart J. 1974 Jan;87(1):11–14. doi: 10.1016/0002-8703(74)90384-6. [DOI] [PubMed] [Google Scholar]
- Tavel M. E. Editorial: The fourth heart sound--a premature requiem? Circulation. 1974 Jan;49(1):4–6. doi: 10.1161/01.cir.49.1.4. [DOI] [PubMed] [Google Scholar]



