Ambulatory Monitoring of Heart Sounds via an Implanted Device Is Superior to Auscultation for Prediction of Heart Failure Events

•S3 identifies patients with 5.7-fold increase in risk of heart failure decompensation.•Deviced-measured S3 (devS3) is superior to auscultation for prognosis.•The superiority of devS3 is sustained for up to 1 year.•Subaudible components of S3 may contribute to its superiority.•DevS3 is objective, co...

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Bibliographic Details
Published in:Journal of cardiac failure 2020-02, Vol.26 (2), p.151-159
Main Authors: Cao, Michael, Gardner, Roy S., Hariharan, Ramesh, Nair, Devi G., Schulze, Christopher, An, Qi, Thakur, Pramodsingh H., Kwan, Brian, Zhang, Yi, Boehmer, John P.
Format: Article
Language:English
Subjects:
heart failure
implantable cardiac devices
remote monitoring
Third heart sound
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Summary:•S3 identifies patients with 5.7-fold increase in risk of heart failure decompensation.•Deviced-measured S3 (devS3) is superior to auscultation for prognosis.•The superiority of devS3 is sustained for up to 1 year.•Subaudible components of S3 may contribute to its superiority.•DevS3 is objective, continuous and automatic and enables remote monitoring. We compared the relationship between the third heart sound (S3) measured by an implantable cardiac device (devS3) and auscultation (ausS3) and evaluated their prognostic powers for predicting heart failure events (HFEs). In the MultiSENSE study, devS3 was measured daily with continuous values, whereas ausS3 was assessed at study visits with discrete grades. They were compared among patients with and without HFEs at baseline and against each other directly. Cox proportional hazard models were developed between follow-up visits and over the whole study. Simulations were performed on devS3 to match the limitations of auscultation. We studied 900 patients, of whom 106 patients experienced 192 HFEs. Two S3 sensing modalities correlated with each other, but at baseline, only devS3 differentiated patients with or without HFEs (P < 0.0001). The prognostic power of devS3 was superior to that of ausS3 both between follow-up visits (HR = 5.7, P < 0.0001, and 1.7, P = 0.047, respectively) and over the whole study (HR = 2.9, P < 0.0001, and 1.4, P = 0.216, respectively). Simulation results suggested this superiority may be attributed to continuous monitoring and to subaudible measuring capability. S3 measured by implantable cardiac devices has stronger prognostic power to predict episodes of future HFEs than that of auscultation.
ISSN:1071-9164
1532-8414
DOI:10.1016/j.cardfail.2019.10.006