rhythm can be heard in some patients with heart
failure and has been shown to be associated with increased
left ventricular end-diastolic pressures. Clinical
studies have shown that the sign has a sensitivity of
30% to 50% and a specificity of 80% to 90%.29,30 The
presence of a left ventricular S3 has also been shown
to correlate with risk of hospitalization and death from
heart failure and progression to heart failure in asymptomatic
individuals.23,26 Although the presence of an S3
is a strong predictor of heart failure, with a specificity
of 99%, it may be difficult to hear an S3 in a noisy acute
care setting.13