440例艾滋病合并结核病临床感染状况的分析

 目的探讨艾滋病合并结核病的临床感染状况。方法回顾性分析440例艾滋病合并结核病的临床感染的类型、部位、合并感染的情况。结果163例(37.05%)为多部位或全身播散性结核;肺外结核高发(143例,32.50%);48例(10.91%)直接表现为肺外结核;8例(1.82%)为成人原发型肺结核。结论结核病是艾滋病最常见及高发的机会性感染。艾滋病合并结核病临床感染状况表现为多部位或全身播散性结核、肺外结核高发,部分病例直接表现为肺外结核及成人原发型肺结核。     

艾滋病合并结核病18例临床分析

目的:探讨艾滋病合并结核病患者的临床特点,提高艾滋病合并结核病的认识.方法:回顾分析2007年7月～2010年7月艾滋病合并结核病18例患者的感染途径、临床表现、高效抗逆转录病毒治疗(HARRT)和抗结核治疗情况.结果:18例患者HIV感染途径为静脉吸毒传播15例,性接触传播3例;其中肺结核13例,结核性胸膜炎2例,结核性腹膜炎2例,腋窝淋巴结结核1例.18例均给予正规抗结核治疗,15例联合HARRT治疗,8例已完成抗结核治疗疗程,死亡4例,失访1例,在治5例.结论:艾滋病合并结核病患者临床表现复杂,合并症多,诊断治疗困难,死亡率高.HARRT治疗联合抗结核治疗可改善艾滋病合并结核病患者的预后.     

艾滋病合并肺结核60例临床分析

目的探讨艾滋病合并肺结核的临床特点及诊治方法,提高艾滋病合并肺结核的诊治水平.方法回顾分析60例艾滋病合并肺结核患者的临床特点、治疗方法及疗效.结果60例艾滋病合并肺结核患者中,45例(75%)反复发热,30例(50%)表现为典型午后低热,咳嗽、咳痰54例(90%),胸痛22例(37%),咯血4例(15%),明显消瘦58例(97%),腹泻3例(5%),淋巴结肿大21例(35%),其中颈淋巴结肿大17例(28%).胸部影像学表现血行播散型肺结核4例(15%),浸润型肺结核40例(67%),结核性胸膜炎16例(27%),其中合并纵膈淋巴结肿大者10例(17%).痰涂找抗酸杆菌阳性10例(17%),CD4计数小于200个∕微升51例(85%),CD4计数大于200个∕微升9例(15%).白细胞计数升高38例(63%),结核菌抗体阳性56例(93%).60例艾滋病合并肺结核患者好转出院43例(72%),病情无好转或恶化17例(28%),无死亡病例.结论对于艾滋病患者是否存在合并肺结核感染,应警惕艾滋病合并肺结核的不典型性,力求完善痰涂、影像学、血常规等检查,在高度怀疑存在合并肺结核的情况下亦应考虑抗结核试验性治疗,并尽快给予HAART抗病毒治疗,以免延误诊治.     

肺结核合并肺外结核242例临床分析

目的 探讨肺结核合并肺外结核的临床特点及继发性肺结核与血行播散性肺结核合并肺外结核的异同。方法 对242例继发性肺结核合并肺外结核和血行播散性肺结核合并肺外结核患者的临床资料以及实验室检查进行回顾性分析。结果 两组患者以21～30岁的年轻人为最多。血行播散性肺结核组有贫血与低蛋白血症的患者明显高于继发性肺结核组(P＜0.01)。血行播散性肺结核组有发热的患者明显高于继发性肺结核组(P＜0.01)。血行播散性肺结核组合并≥3种肺外结核的患者明显高于继发性肺结核组(P＜0.05)。继发性肺结核组痰涂片阳性率明显高于血行播散性肺结核组(P<0.01)。在继发性肺结核组,肺部病灶范围分布在6个肺野的患者最多。血行播散性肺结核组合并结核性脑膜炎/脑结核的患者明显高于继发性肺结核组(P＜0.01)。继发性肺结核组合并浅表淋巴结结核的患者明显高于血行播散性肺结核组(P＜0.01)。继发性肺结核组合并胸壁结核的患者明显高于血行播散性肺结核组(P＜0.01)。两组合并脊柱结核、肠结核、喉结核、泌尿系结核、结核性腹膜炎无差异(P>0.05)。结论 对年轻、肺部结核病灶范围广、全身情况差的肺结核患者,要警惕同时合并肺外结核,尤其是合并结核性脑膜炎/脑结核、浅表淋巴结结核、脊柱结核。     

CD4~+T细胞极低艾滋病患者合并肺结核21例临床分析

目的分析CD4~+T细胞计数极低艾滋病合并肺结核患者的临床特点,为临床诊治提供依据。方法选择CD4~+T细胞计数低于50个/μL艾滋病合并肺结核患者21例给予规律抗结核治疗,适时给予抗逆转录病毒治疗(ART)。收集相关的临床和实验室数据,包括临床症状、影像学、免疫学和病原学检查结果等。结果患者主要临床表现有持续发热、消瘦、淋巴结肿大及肺外结核和肺部多重感染,影像学表现广泛浸润9例、粟粒样浸润6例、纵膈淋巴结肿大11例。结核菌素试验(TST)阳性率14.3%,结核病原学检查阳性8例。及时抗结核、抗病毒及防治其他机会性感染,19例病情得到有效控制,2例救治无效死亡。结论 CD4~+T细胞计数极低的艾滋病合并肺结核患者临床表现复杂多样,及时诊断及合理治疗能取得良好疗效。艾滋病合并肺结核患者的临床特点及治疗与CD4~+T细胞水平有相关性。     

肺结核合并糖尿病55例临床分析

目的探讨肺结核合并糖尿病的临床特点,及血糖控制水平与抗结核治疗的效果关系。方法对115例肺结核患者（其中有55例肺结核患者合并糖尿病）的临床资料进行回顾性分析。结果相对于单纯的肺结核患者而言,合并有糖尿病的肺结核患者其结核中毒症状更明显,结核空洞的发生率高,痰结核菌阳性率高;血糖水平控制理想者,抗结核治疗效果佳。结论肺结核合并有糖尿病的患者,结核中毒症状较重,传染性较强,控制好血糖水平有利于结核病的治疗。     

艾滋病合并肺结核患者的肺部影像学分析

目的分析艾滋病合并肺结核患者的肺部影像学特征,提高影像诊断医师对其的认识水平和诊断率。方法总结我院收治21例艾滋病合并肺结核患者的临床资料,对其肺部影像进行回顾性分析。结果 21例艾滋病合并肺结核患者中,19例累及2个或2个以上肺段,其中肺浸润17例,肺门和（或）纵隔淋巴结肿大9例,弥散性粟粒性病灶11例,肺外结核4例。结论艾滋病合并肺结核多具有不典型肺结核特征,其对临床诊断和治疗有重要的意义。     

肺结核X线诊断分类探讨

目的:明确肺结核X线分类中两型合并的分类。方法:收集临床、肺结核细菌学和常规胸片确诊的肺结核500例,进行X线分类探讨。结果:X线分类,原发型107例,合并胸膜炎6例;血行播散型70例,合并胸膜炎22例;继发型306例,合并胸膜炎74例;结核性胸膜炎17例。I型～III型肺结核合并胸膜炎102例,占总病例数的20.4%。结论:依据病因发病机理,中国结核病分类法,按原发型肺结核合并结核性胸膜炎,血行播散型肺结核合并结核性胸膜炎,继发型肺结核合并结核性胸膜炎,进行X线分型。     

肺结核X线诊断分类

目的:明确肺结核X线分类中两型合并的分类。方法:收集临床、肺结核细菌学和常规胸片确诊的肺结核500例,进行X线分类探讨。结果:x线分类,原发型107例,合并胸膜炎6例;血行播散刑70例,合并胸膜炎22例;继发刑306例,合并胸膜炎74例:结核性胸膜炎17例。I～III型肺结核合并胸膜炎102例,占总病例数的20.4%。结论:依据病因发病机理,中国结核病分类法,按原发刑肺结核合并结核性胸膜炎,血行播散俐肺结核合并结核性胸膜炎,继发型肺结核合并结核性胸膜炎,进行X线分型。     

肺结核X线诊断分类探讨

目的：明确肺结核X线分类中两型合并的分类。方法：收集临床、肺结核细菌学和常规胸片确诊的肺结核500例，进行X线分类探讨。结果：X线分类，原发型107例，合并胸膜炎6例；血行播散型70例，合并胸膜炎22例；继发型306例，合并胸膜炎74例；结核性胸膜炎17例。I型～Ⅲ型肺结核合并胸膜炎102例，占总病例数的20．4％。结论：依据病因发病机理，中国结核病分类法，按原发型肺结核合并结核枉胸膜炎．血行播散型肺结核合并结核性，胸膜炎，继发型肺结核合并结核性胸膜炎，进行X线分型。     

严重急性呼吸综合征的临床特点及遗留肺纤维化相关因素分析

目的分析严重急性呼吸综合征(SARS)患者急性期的临床特点及诊治经验,探讨SARS患者遗留肺纤维化病变的相关因素。方法对54例SARS患者的急性期临床资料进行回顾性分析,对各组数据进行统计学分析。结果38例(70.4%)患者有明确的SARS接触史,潜伏期为1~16 d,平均(6±4)d。92.6%的患者以发热为首发症状。氧合指数(PaO2/FiO2)≤200者14.8%(7/47),PaO2/FiO2介于200~300之间者42.6%(20/47)。白细胞总数、淋巴细胞绝对值计数及血小板降低者分别为24.1%、46.2%和10.0%,心肌酶异常升高的患者占44.4%。CT影像以不规则实变融合病灶或伴支气管充气征(61.1%)及双肺弥散性磨玻璃影或碎石路样改变(53.7%)为主。病灶常累及双肺,以双下肺受累为主。重症SARS组应用激素和无创通气治疗的比例(100%、55.6%)均高于普通SARS组(77.8%、9.0%)(P<0.01和P<0.05)。营养支持及提高免疫力等治疗是有效的辅助措施。肺纤维化遗留组急性期的肺部病灶累及肺叶数量多、氧合指数低,与无肺纤维化遗留组比较差异均有统计学意义(P<0.01)。结论SARS的发病与密切接触病人有关,肺CT对于早期诊断至关重要,综合治疗措施可以取得很好的治疗效果。急性期肺部病灶累及肺叶数量多、氧合指数低的SARS患者易遗留肺纤维化。     

Molecular and Geographic Patterns of Tuberculosis Transmission After 15 Years of Directly Observed Therapy

Context.— Recent studies suggest that one third of tuberculosis cases in urban areas result from recent transmission. Improved tuberculosis control measures such as uniform implementation of directly observed therapy might reduce the proportion of cases resulting from recent transmission. Objective.— To determine patterns of tuberculosis transmission in Baltimore, Md, after 15 years of community-based directly observed therapy. Design.— A 30-month (January 1994-June 1996), prospective, city-wide study of all cases of tuberculosis using traditional contact investigations, geographic information systems data, and molecular epidemiologic comparison of Mycobacterium tuberculosis isolates with 2 DNA probes. Patients.— One hundred eighty-two patients with culture-positive tuberculosis. Main Outcome Measures.— Proportion of disease defined as recently transmitted based on epidemiologic linkage by traditional contact tracing and molecular linkage by DNA fingerprint analysis of isolates; geographic foci of transmission based on linkage of residences by geographic information systems data. Results.— Of the 182 patients who had isolates of M tuberculosis available, 84 (46%) showed molecular clustering with 58 (32%) defined as being recently transmitted. Only 20 (24%) of 84 cases with clustered DNA fingerprints had epidemiologic evidence of recent contact. Geographic analysis showed significant spatial aggregation of the 20 clustered cases with epidemiologic links (P<.001), occurring in areas of low socioeconomic status and high drug use. The 64 cases with clustered DNA fingerprints but without epidemiologic links shared common risk factors and demographic features with the 20 clustered patients who did have epidemiologic links. Conclusions.— Recently transmitted tuberculosis accounts for a high proportion of tuberculosis cases in Baltimore. Recently transmitted cases occur in geographically distinct areas of Baltimore, and location-based control efforts may be more effective than contact tracing for the early identification of cases.      

对539例HIV感染者皮肤黏膜表现的临床分析

目的通过研究H IV感染者/AIDS患者皮肤黏膜表现的种类数及严重程度及其与CD4+T淋巴细胞计数、CD4+/CD8+比值的关系,评估皮肤黏膜病变作为预测和评估患者免疫状态的临床指标的可行性。方法对北京佑安医院2001年5月~2006年4月收集的539例住院及门诊H IV感染者/AIDS患者的临床资料作回顾性研究,采用流式细胞仪技术检测350例出现不同皮肤黏膜表现及189例无皮肤黏膜表现患者的CD4+T细胞计数、CD4+/CD8+比值,观察H IV感染人群中各种皮肤病的发生率,并研究出现皮肤病的种类数、严重程度与艾滋病患者免疫功能的相关性。结果H IV阳性患者的皮肤病发生率为65%,其中口腔黏膜念珠菌感染最常见。H IV阳性有皮肤黏膜表现组CD4+T细胞计数的平均数与CD4+/CD8+比值(分别为53.04个/μL与0.202 4)明显低于无皮肤黏膜表现组(分别为281.97个/μL与0.312 9),2组间比较差异具有明显的统计学意义(P<0.05),且CD4+T细胞计数与所患皮肤病的种类数及严重程度呈负相关。结论H IV感染者/AIDS患者的常见皮肤病临床表现,即患者皮肤疾病的种类数、发生率及严重程度与CD4+T细胞计数呈负相关,某些皮肤黏膜表现可以作为预测和评估资源有限国家患者免疫状态的临床指标。     

Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49)

Context  Treatment with diet alone, insulin, sulfonylurea, or metformin is known to improve glycemia in patients with type 2 diabetes mellitus, but which treatment most frequently attains target fasting plasma glucose (FPG) concentration of less than 7.8 mmol/L (140 mg/dL) or glycosylated hemoglobin A_1c(HbA_1c) below 7% is unknown. Objective  To assess how often each therapy can achieve the glycemic control target levels set by the American Diabetes Association. Design  Randomized controlled trial conducted between 1977 and 1997. Patients were recruited between 1977 and 1991 and were followed up every 3 months for 3, 6, and 9 years after enrollment. Setting  Outpatient diabetes clinics in 15 UK hospitals. Patients  A total of 4075 patients newly diagnosed as having type 2 diabetes ranged in age between 25 and 65 years and had a median (interquartile range) FPG concentration of 11.5 (9.0-14.4) mmol/L [207 (162-259) mg/dL], HbA_1c levels of 9.1% (7.5%-10.7%), and a mean (SD) body mass index of 29 (6) kg/m². Interventions  After 3 months on a low-fat, high-carbohydrate, high-fiber diet, patients were randomized to therapy with diet alone, insulin, sulfonylurea, or metformin. Main Outcome Measures  Fasting plasma glucose and HbA_1c levels, and the proportion of patients who achieved target levels below 7% HbA_1c or less than 7.8 mmol/L (140 mg/dL) FPG at 3, 6, or 9 years following diagnosis. Results  The proportion of patients who maintained target glycemic levels declined markedly over 9 years of follow-up. After 9 years of monotherapy with diet, insulin, or sulfonylurea, 8%, 42%, and 24%, respectively, achieved FPG levels of less than 7.8 mmol/L (140 mg/dL) and 9%, 28%, and 24% achieved HbA_1c levels below 7%. In obese patients randomized to metformin, 18% attained FPG levels of less than 7.8 mmol/L (140 mg/dL) and 13% attained HbA_1c levels below 7%. Patients less likely to achieve target levels were younger, more obese, or more hyperglycemic than other patients. Conclusions  Each therapeutic agent, as monotherapy, increased 2- to 3-fold the proportion of patients who attained HbA_1c below 7% compared with diet alone. However, the progressive deterioration of diabetes control was such that after 3 years approximately 50% of patients could attain this goal with monotherapy, and by 9 years this declined to approximately 25%. The majority of patients need multiple therapies to attain these glycemic target levels in the longer term.      

Effect of homocysteine-lowering therapy with folic acid,vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention: the Swiss Heart study: a randomized controlled trial

Context  Plasma homocysteine level has been recognized as an important cardiovascular risk factor that predicts adverse cardiac events in patients with established coronary atherosclerosis and influences restenosis rate after percutaneous coronary intervention. Objective  To evaluate the effect of homocysteine-lowering therapy on clinical outcome after percutaneous coronary intervention. Design, Setting, and Participants  Randomized, double-blind placebo-controlled trial involving 553 patients referred to the University Hospital in Bern, Switzerland, from May 1998 to April 1999 and enrolled after successful angioplasty of at least 1 significant coronary stenosis (50%). Intervention  Participants were randomly assigned to receive a combination of folic acid (1 mg/d), vitamin B₁₂ (cyanocobalamin, 400 µg/d), and vitamin B₆ (pyridoxine hydrochloride, 10 mg/d) (n = 272) or placebo (n = 281) for 6 months. Main Outcome Measure  Composite end point of major adverse events defined as death, nonfatal myocardial infarction, and need for repeat revascularization, evaluated at 6 months and 1 year. Results  After a mean (SD) follow-up of 11 (3) months, the composite end point was significantly lower at 1 year in patients treated with homocysteine-lowering therapy (15.4% vs 22.8%; relative risk [RR], 0.68; 95% confidence interval [CI], 0.48-0.96; P = .03), primarily due to a reduced rate of target lesion revascularization (9.9% vs 16.0%; RR, 0.62; 95% CI, 0.40-0.97; P = .03). A nonsignificant trend was seen toward fewer deaths (1.5% vs 2.8%; RR, 0.54; 95% CI, 0.16-1.70; P = .27) and nonfatal myocardial infarctions (2.6% vs 4.3%; RR, 0.60; 95% CI, 0.24-1.51; P = .27) with homocysteine-lowering therapy. These findings remained unchanged after adjustment for potential confounders. Conclusion  Homocysteine-lowering therapy with folic acid, vitamin B₁₂, and vitamin B₆ significantly decreases the incidence of major adverse events after percutaneous coronary intervention.      

Admission Trends in a Rural South African Hospital During the Early Years of the HIV Epidemic

Katherine Floyd, MA, MSc; R. Alasdair Reid, MRCP, DTM&H; David Wilkinson, BSc, MSc, MBChB; Charles F. Gilks, DPhil, FRCP

JAMA. 1999;282:1087-1091.

Context  Few studies have attempted to quantify the effect of the epidemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on demand for health care in developing countries. More data are required to improve understanding of its impact and to guide development of appropriate response strategies.

Objective  To assess the HIV/AIDS epidemic's impact on demand for inpatient hospital care in a rural area of South Africa.

Design  Retrospective analysis of data from general hospital and individual ward admission registers, a tuberculosis program database, and patient case notes.

Setting and Patients  Patients admitted between 1991 and 1998 to a 450-bed hospital that serves Hlabisa District, South Africa (population 200,000), where HIV seroprevalence among antenatal clinic attendees increased from 4% in 1992 to 29% in 1998.

Main Outcome Measures  Number of admissions to 9 hospital wards, number of clinical AIDS and general medical admissions (both excluding tuberculosis), and number of tuberculosis admissions to adult medical wards during the study period.

Results  Total hospital admissions increased by 81%, from 6562 in 1991 to 11,872 in 1998. Adult tuberculosis ward admissions increased by 360%, from 303 to 1393. In 1998, tuberculosis patients accounted for 47% and 30% of adult male and female medical ward admissions, respectively, and for 11% of total hospital admissions. Nontuberculosis clinical AIDS cases increased 43-fold, accounting for 4% of adult medical admissions in 1997 vs 0.2% in 1991. Tuberculosis and nontuberculosis clinical AIDS cases were the only types of admission to show a clear and consistent upward trend over the period studied. Patterns in other types of admissions varied more and changes were smaller.

Conclusions  The HIV/AIDS epidemic has had an important impact on demand for adult tuberculosis and general medical care in a rural South African district hospital. If this impact is shown to extend to other rural South African areas, response strategies are urgently needed.

     

艾滋病合并肺结核10例临床分析

目的探讨艾滋病合并肺结核的临床特点，治疗及预后。．方法对上海市公共卫生临床中心2005年1月至2005年12月间收治的10例艾滋病合并肺结核病人和5例艾滋病未合并肺结核病人（仅用于病死率与CD4细胞计数对照）的临床特点进行分析。结果10例艾滋病合并肺结核病人中青壮年占90％（9／10），半年内病死4例（40％，4／10）；HIV感染途径为静脉吸毒1例（10％，1／10），输血或血液制品3例（30％，3／10），性接触6例（60％，6／10）；临床表现为持续发热（100％），咳嗽、咳痰（70％，7／10），明显消瘦（80％，8／10），淋巴结肿大（40％，4／10），皮肤溃烂（20％，2／10），X线表现为血行播散型肺结核（80％，8／10），合并淋巴结结核（20％，2／10）；蛋白纯化衍生物（PPD）试验弱阳性1例（10％，1／10）；经抗结核及抗HIV治疗，病人多数症状、体征及胸片改善；抗结核治疗不良反应发生率高。结论艾滋病合并肺结核发病急，症状重，多见高热不退及血行播散型肺结核，病死率高。病死率与CD4细胞计数相关。10例病人治疗前CD^＋4明显低于5例未合并结核病的艾滋病病人（P〈0．05）；而10例中，4例病死病人治疗前CD^＋4也较存活病人明显降低（P〈0．05）。PPD试验阳性率低，抗结核药物治疗不良反应多，临床应尽可能同时进行抗结核与抗HIV治疗。     

靶控输注丙泊酚行钬激光输尿管镜碎石术

目的研究靶控输注丙泊酚联合应用舒芬太尼用于钬激光经尿道输尿管镜碎石术的可行性和安全性。方法将30位择期行钬激光经尿道输尿管镜碎石术患者,ASAⅠ-Ⅱ级,随机分为两组,两组均于入室后静注舒芬太尼0.1μg.kg-1,给药后3min靶控输注丙泊酚,一组丙泊酚靶浓度为3μg.mL-1(G1组,n=15),另一组丙泊酚靶浓度为4μg.mL-1(G2组,n=15);待效应室浓度达预定值后开始操作,术中根据体动情况可单次追加丙泊酚,同时使术中BIS<60,若脉搏血氧饱和度低于90%给予面罩加压给氧。在麻醉中观察并记录血压、心率、脉搏血氧饱和度、BIS值、镇静分级(RAMSAY评分)、并发症发生率(呼吸抑制、血压下降、恶心、呕吐、咳嗽和躁动)以及丙泊酚用药总量、追加次数、意识恢复时间(从停丙泊酚至呼之睁眼及定向力恢复),并在两组间进行比较。结果两组患者镇静效果分级均为4～5分,G1组和G2组平均BIS值分别为59±10和56±13(P>0.05),均达到足够镇静深度。两组患者靶控至预定浓度后血压有明显下降,进镜时血压、心率、血氧饱和度与入室时组间比较差异无统计学意义(P>0.05),G1组与G2组辅助呼吸发生率为2/15和8/15(χ2:P=0.02)。G1组和G2组术中轻微体动的发生率分别为5/15和1/15(χ2:P=0.08)。G1组与G2组的呼之睁眼时间为(2.8±1.1)min和(8.3±3.0)min,定向力恢复时间为(7.6±1.9)min和(15.6±2.2)min(P<0.01)。丙泊酚总用药量分别为(225.5±77.7)mg和(342.5±72.6)mg(P<0.01)。术后随访表明对内镜操作均无记忆。结论本实验中舒芬太尼与丙泊酚复合麻醉,对于钬激光输尿管镜碎石术能达到足够的麻醉深度,两组麻醉剂量均具有安全性和可行性。靶控浓度3μg.mL-1组可减轻呼吸抑制、缩短术后清醒时间,同时节省丙泊酚用药总量。     

Association between phonocardiographic third and fourth heart sounds and objective measures of left ventricular function

Context  The third (S₃) and fourth (S₄) heart sounds detected by phonocardiography are considered to represent the criterion standards of the gallop sounds, but their test characteristics have not been explored. Objective  To determine the diagnostic test characteristics of the S₃ and S₄ for prediction of left ventricular dysfunction using a computerized heart sound detection algorithm. Design, Setting, and Participants  Prospective study of 90 adult patients undergoing elective left-sided heart catheterization at a single US teaching hospital between August 2003 and June 2004. The mean age was 62 (SD, 13) years (range, 24-90 years) and 61 (68%) were male. Within a 4-hour period, participants underwent computerized heart sound phonocardiographic analysis, cardiac catheterization, transthoracic echocardiography, and blood sampling for assessment of an S₃/S₄, left ventricular end-diastolic pressure (LVEDP), left ventricular ejection fraction (LVEF), and B-type natriuretic peptide (BNP), respectively. Main Outcome Measures  Diagnostic test characteristics of the computerized phonocardiographic S₃ and S₄ using markers of left ventricular function as criterion standards. Results  Mean (SD) LVEDP was significantly elevated (18.4 [6.9] mm Hg vs 12.1 [7.3] mm Hg; P<.001), mean (SD) LVEF was reduced (49.4% [20.2%] vs 63.6% [14.8%]; P<.001), and median (interquartile range) BNP was elevated (330 [98-1155] pg/mL vs 86 [41-192] pg/mL; P<.001) in those with an S₃, S₄, or both compared with patients without a diastolic heart sound. The sensitivities of these heart sounds to detect an elevated LVEDP, reduced LVEF, or elevated BNP were 41%, 52%, and 32% for an S₃, and 46%, 43%, and 40% for an S₄, respectively. For abnormal levels of the same markers of ventricular function, the specificities of the S₃ were 92%, 87%, and 92%, while the specificities of the S₄ were 80%, 72%, and 78%, respectively. Conclusions  Neither the phonocardiographic S₃ nor the S₄ is a sensitive marker of left ventricular dysfunction. The phonocardiographic S₃ is specific for left ventricular dysfunction and appears to be superior to the moderate specificity of the phonocardiographic S₄.