Heart failure & cardiomyopathies
Importance of Fourth Heart Sound and Preserved Left Atrial Function in Wild-Type Transthyretin Amyloidosis
Authors' conclusion
S4 was present in 47% of the patients in SR with ATTRwt-CM. Patients in SR without S4 had more impaired LA systolic function than those in SR with S4. The absence of S4 portends a poor short-term prognosis in patients with ATTRwt-CM.
Study context
- Population
- Patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) who had undergone phonocardiography36 in sinus rhythm (SR)
- Participants
- 76 patients
- Exposure
- SR with S4 vs SR without S4 vs non-SR
- SR with S4n = 17
- non-SRn = 40
- Outcome
- Clinical implications of S4 (presence of S4 on PCG)
Main finding
As reported in the abstract
S4 presence in SR (n = 36)
SR with S4
47%
17
- Distinct S4 recognized by auscultation
- 7 patients (19%)
Observational data: associations, not effects.
Further findings
| Outcome | SR with S4 | SR without S4 | P value |
|---|---|---|---|
| SBP (SR patients)SR with S4 vs SR without S4 · mean, mmHg | 124 (SD 15) | 99 (SD 8) | P < 0.001 |
| Plasma BNP (SR patients)SR with S4 vs SR without S4 | 308 (IQR 165–354) pg/mL | 508 (IQR 389–765) pg/mL | P = 0.034 |
| High-sensitivity cardiac troponin T (SR patients)SR with S4 vs SR without S4 | 0.068 (IQR 0.046–0.089) ng/mL | 0.109 (IQR 0.063–0.148) ng/mL | P = 0.042 |
- Peak atrial filling velocity (left atrium (LA) systolic function) · SR with S4 vs SR without S4
- P = 0.033
- LA contractile strain (LA systolic function) · SR with S4 vs SR without S4
- P = 0.012
- Short-term prognosis · SR without S4 vs SR with S4 and non-SR · generalized Wilcoxon test; worse with SR without S4
- P = 0.033
LA volume index and LA reservoir strain
- No significant difference between patients with and without S4
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Importance of Fourth Heart Sound and Preserved Left Atrial Function in Wild-Type Transthyretin Amyloidosis. ESC Heart Fail. Published 1 August 2024. doi:10.
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