Diagnostic Ability of Physical Examination in Aortic Valve Stenosis

Jorge Parras, José M. Escalante, Juan M. Lange


Background: Physical examination is essential to detect aortic stenosis but there is scarce information currently available.Objectives: The goal of this study is to evaluate the diagnostic yield of physical examination, the interobserver agreement ofclinical signs, and to establish a score to identify severe aortic stenosis.Methods: One-hundred patients were included in the study. Before echocardiographic evaluation, two cardiologists independentlyevaluated the clinical signs of the physical examination in aortic stenosis. Sensitivity, specificity, and inter-observeragreement were calculated, and the area under the curve was analyzed to develop a score for predicting severe aortic stenosis.Results: The decreased intensity of the first heart sound and the crescendo-decrescendo shape of the murmur had sensitivity>90% and specificity <70%.The specificities of an absent second sound, a murmur that peaks later in systole and the presence of a parvus et tardus pulsewere >95%, but the sensitivities were <50%.Inter-observer agreement was good for most criteria, except for murmur shape and intensity. The best area under the curvewas achieved by the score composed of heart sounds of decreased or absent intensity, duration of the holosystolic murmur,parvus et tardus carotid pulse and a grade 3-4 systolic murmur.Conclusions: Physical examination findings have low sensitivity but good specificity. Inter-observer agreement of clinicalsigns of severity was moderately good. Correct identification of patients with severe aortic stenosis can be achieved using asimple score.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar