AUTHOR=Fujiyoshi Kazuhiro , Yamaoka-Tojo Minako , Fujiyoshi Kanako , Komatsu Takumi , Oikawa Jun , Kashino Kunio , Tomoike Hitonobu , Ako Junya 

TITLE=Beat-to-beat alterations of acoustic intensity and frequency at the maximum power of heart sounds are associated with NT-proBNP levels

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1372543

DOI=10.3389/fcvm.2024.1372543

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Auscultatory features of heart sounds (HS) in patients with heart failure (HF) have been studied intensively. Recent developments in digital and electrical devices for auscultation provided easy listening chances to recognize peculiar sounds related to diastolic HS such as S<sub>3</sub> or S<sub>4</sub>. This study aimed to quantitatively assess HS by acoustic measures of intensity (dB) and audio frequency (Hz).</p></sec><sec><title>Methods</title><p>Forty consecutive patients aged between 46 and 87 years (mean age, 74 years) with chronic cardiovascular disease (CVD) were enrolled in the present study after providing written informed consent during their visits to the Kitasato University Outpatient Clinic. HS were recorded at the fourth intercostal space along the left sternal border using a highly sensitive digital device. Two consecutive heartbeats were quantified on sound intensity (dB) and audio frequency (Hz) at the peak power of each spectrogram of S<sub>1</sub>–S<sub>4</sub> using audio editing and recording application software. The participants were classified into three groups, namely, the absence of HF (<italic>n</italic> = 27), HF (<italic>n</italic> = 8), and high-risk HF (<italic>n</italic> = 5), based on the levels of NT-proBNP &lt; 300, ≥300, and ≥900 pg/ml, respectively, and also the levels of ejection fraction (EF), such as preserved EF (<italic>n</italic> = 22), mildly reduced EF (<italic>n</italic> = 12), and reduced EF (<italic>n</italic> = 6).</p></sec><sec><title>Results</title><p>The intensities of four components of HS (S<sub>1</sub>–S<sub>4</sub>) decreased linearly (<italic>p</italic> &lt; 0.02–0.001) with levels of body mass index (BMI) (range, 16.2–33.0 kg/m<sup>2</sup>). Differences in S<sub>1</sub> intensity (ΔS<sub>1</sub>) and its frequency (Δ<italic>fS<sub>1</sub></italic>) between two consecutive beats were non-audible level and were larger in patients with HF than those in patients without HF (ΔS<sub>1</sub>, <italic>r</italic> = 0.356, <italic>p</italic> = 0.024; Δ<italic>fS<sub>1</sub></italic>, <italic>r</italic> = 0.356, <italic>p</italic> = 0.024). The cutoff values of ΔS<sub>1</sub> and Δ<italic>fS<sub>1</sub></italic> for discriminating the presence of high-risk HF were 4.0 dB and 5.0 Hz, respectively.</p></sec><sec><title>Conclusions</title><p>Despite significant attenuations of all four components of HS by BMI, beat-to-beat alterations of both intensity and frequency of S<sub>1</sub> were associated with the severity of HF. Acoustic quantification of HS enabled analyses of sounds below the audible level, suggesting that sound analysis might provide an early sign of HF.</p></sec>