Value of the cardiovascular physical examination for detecting valvular heart disease in asymptomatic subjects

https://doi.org/10.1016/S0002-9149(96)00200-7Get rights and content

Abstract

To determine the accuracy of the cardiovascular physical examination for the diagnosis of asymptomatic valvular heart disease (VHD), we prospectively studied 143 subjects, 68 apparent normal subjects and 75 patients with diseases known to produce VHD. All subjects underwent a complete physical examination with dynamic cardiac auscultation by a physician blinded to clinical data and compared with the results of transesophageal color Doppler echocardiography (TEE). By TEE, 33 subjects (23%), and by physical examination, 25 subjects (17%) had at least 1 form of VHD. Despite a high frequency of mild valve abnormalities and a 31% prevalence of functional murmurs, the physical examination showed a sensitivity of 70%, a specificity of 98% (confidence interval = 0.51 to 0.84, and 0.94 to 0.99, respectively), and a positive and negative predictive value of 92% for the diagnosis of VHD. Only 2 of the 10 patients with VHD by TEE, but not by physical examination, had clinically important VHD. We conclude that the physical examination is a sensitive and highly specific method of screening for VHD in subjects without cardiac symptoms. Therefore, its use should be encouraged rather than the routine application of echocardiography.

References (26)

  • AE Weyman et al.

    Cross-sectional echocardiographic visualization of the stenotic pulmonary valve

    Circulation

    (1977)
  • J Tunon et al.

    Assessment of chronic tricuspid regurgitation by color Doppler echocardiography: a comparison with angiography in the catheterization room

    Eur Heart J

    (1994)
  • PJ Currie et al.

    Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients

    Circulation

    (1985)
  • Cited by (118)

    • Utility of Echocardiogram in the Evaluation of Heart Murmurs

      2016, Medical Clinics of North America
      Citation Excerpt :

      Only 2 of the 8 patients in the TEE group that were identified with VHD outside the physical examination cohort actually had clinically significant VHD. The overall conclusion of the study was that the physical examination still remains the gold standard in assessing cardiac murmurs rather than routine application of echocardiography.13 Attenhofer Jost and colleagues8 conducted a similar study, involving 100 patients, to determine whether physical examination can reliably assess systolic murmurs of various causes.

    • The need for annual echocardiography to detect cabergoline-associated valvulopathy in patients with prolactinoma: A systematic review and additional clinical data

      2015, The Lancet Diabetes and Endocrinology
      Citation Excerpt :

      Cardiovascular examination should be the initial screening procedure for clinically significant valvular heart disease in routine clinical practice, although this method is underused.7 In asymptomatic participants, a cardiovascular examination has a very high specificity and both positive and negative predictive values for valvular heart disease.8 This finding suggests that the prevalence of clinically significant valvular disease is low when a normal examination is recorded.

    View all citing articles on Scopus
    View full text