Department of Cardiology, Matsushita Memorial Hospital.
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Int Heart J. 2022 Jul 30;63(4):729-733. doi: 10.1536/ihj.22-025. Epub 2022 Jul 14.
Conventional phonocardiography is useful for objective assessment of cardiac auscultation, but its availability is limited. More recently, an ankle-brachial index (ABI) measurement system equipped with simple phonocardiography has become widely used for diagnosing peripheral artery disease, however, whether this simple phonocardiography can be an alternative to conventional phonocardiography remains unclear.This retrospective study consisted of 48 patients with hypertrophic cardiomyopathy (HCM) and 107 controls. The presence of the fourth sound (S4) was assessed by conventional phonocardiography, in addition to apexcardiography and auscultation, in all patients with HCM. S4 was also estimated by the ABI measurement system with the phonocardiographic microphone on the sternum (the standard method) or at the apex (the apex method) in HCM patients and controls.S4 on conventional phonocardiography was detected in 42 of 48 patients (88%) with HCM. Auscultation for the detection of S4 had a sensitivity of 0.78, specificity of 0.57, and accuracy of 0.75. These diagnostic values were generally superior to those of the standard method using the ABI measurement system, whereas the apex method using the ABI measurement system had better diagnostic values, with an excellent specificity of 1.0, sensitivity of 0.77, and accuracy of 0.80. No significant differences were observed in low ABI defined as < 0.9.Simple phonocardiography equipped with the ABI measurement system may be an alternative to conventional phonocardiography for the detection of S4 in patients with HCM when the phonocardiographic microphone is moved from the sternum to the apex.
传统的心音图对于客观评估心脏听诊非常有用，但可用性有限。最近，一种配备简单心音图的踝臂指数（ABI）测量系统已广泛用于诊断外周动脉疾病，但简单心音图是否可以替代传统心音图尚不清楚。本回顾性研究纳入了 48 例肥厚型心肌病（HCM）患者和 107 例对照者。所有 HCM 患者均通过传统心音图、心尖图和听诊评估第四心音（S4）的存在。HCM 患者和对照者还通过 ABI 测量系统上胸骨的心音图麦克风（标准方法）或心尖（心尖方法）评估 S4。48 例 HCM 患者中有 42 例（88%）在传统心音图上检测到 S4。听诊检测 S4 的灵敏度为 0.78，特异性为 0.57，准确性为 0.75。这些诊断值通常优于使用 ABI 测量系统的标准方法，而使用 ABI 测量系统的心尖方法具有更好的诊断值，特异性为 1.0，灵敏度为 0.77，准确性为 0.80。低 ABI（定义为 < 0.9）时，差异无统计学意义。当心音图麦克风从胸骨移动到心尖时，配备 ABI 测量系统的简单心音图可能是 HCM 患者检测 S4 的传统心音图的替代方法。
