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Auscultation

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Justin Godown – 1st expert on this subject based on the ideXlab platform

  • handheld echocardiography versus Auscultation for detection of rheumatic heart disease
    Pediatrics, 2015
    Co-Authors: Justin Godown, Jimmy C Lu, Andrea Beaton, Craig Sable, Grace Mirembe, Richard Sanya, Twalib Aliku, Sunkyung Yu, Peter Lwabi, Catherine L Webb

    Abstract:

    BACKGROUND: Rheumatic heart disease (RHD) remains a major public health concern in developing countries, and routine screening has the potential to improve outcomes. Standard portable echocardiography (STAND) is far more sensitive than Auscultation for the detection of RHD but remains cost-prohibitive in resource-limited settings. Handheld echocardiography (HAND) is a lower-cost alternative. The purpose of this study was to assess the incremental value of HAND over Auscultation to identify RHD. METHODS: RHD screening was completed for schoolchildren in Gulu, Uganda, by using STAND performed by experienced echocardiographers. Any child with mitral or aortic regurgitation or stenosis plus a randomly selected group of children with normal STAND findings underwent HAND and Auscultation. STAND and HAND studies were interpreted by 6 experienced cardiologists using the 2012 World Heart Federation criteria. Sensitivity and specificity of HAND and Auscultation for the detection of RHD and pathologic mitral or aortic regurgitation were calculated by using STAND as the gold standard. RESULTS: Of 4773 children who underwent screening with STAND, a subgroup of 1317 children underwent HAND and Auscultation. Auscultation had uniformly poor sensitivity for the detection of RHD or valve disease. Sensitivity was significantly improved by using HAND compared with Auscultation for the detection of definite RHD (97.8% vs 22.2%), borderline or definite RHD (78.4% vs 16.4%), and pathologic aortic insufficiency (81.8% vs 13.6%). CONCLUSIONS: Auscultation alone is a poor screening test for RHD. HAND significantly improves detection of RHD and may be a cost-effective screening strategy for RHD in resource-limited settings.

  • abstract 11256 handheld echocardiography improves detection of rheumatic heart disease in ugandan schoolchildren compared to Auscultation
    Circulation, 2014
    Co-Authors: Justin Godown, Jimmy C Lu, Andrea Beaton, Craig Sable, Grace Mirembe, Richard Sanya, Twalib Aliku, Sunkyung Yu, Gregory Ensing

    Abstract:

    Background: Rheumatic heart disease (RHD) remains a major public health concern in developing countries and routine screening has the potential to improve outcomes. Standard portable echocardiography (SPE) is far more sensitive than Auscultation for the detection of RHD, but remains cost-prohibitive in resource-limited settings. With its lower cost, handheld echocardiography (HHE) has the potential to fill this void. The purpose of this study was to assess the incremental value of HHE over Auscultation to identify RHD, as compared to SPE. Methods: Over 1 week, children at 5 schools in Gulu, Uganda underwent focused SPE (parasternal and apical views). Any child with mitral or aortic regurgitation or stenosis, plus a randomly selected group of children with normal SPE findings underwent HHE by echocardiographers and Auscultation by a local physician. SPE and HHE studies were interpreted blindly using the 2012 World Heart Federation criteria by 6 experienced cardiologists. A second reader confirmed any study with borderline or definite RHD, with discrepancies resolved by a third reader. Sensitivity and specificity of HHE and Auscultation for the detection of any RHD, definite RHD, and pathologic mitral or aortic regurgitation were calculated using SPE as the gold standard. Results: Of 4,773 children who underwent screening with SPE, a subgroup of 1,317 children (46 % male, 10.8 ± 2.6 years of age) underwent HHE and Auscultation. Auscultation had uniformly poor sensitivity to detect RHD or valve disease. Sensitivity was significantly improved using HHE compared to Auscultation for the detection of definite RHD (97.8% vs 22.2%), borderline or definite RHD (78.4% vs 16.4%), and pathologic aortic insufficiency (81.8% vs 13.6%) (Table). Conclusions: Auscultation is a poor screening test for the detection of RHD. HHE significantly improves detection of RHD and may be a useful adjunct to or replacement of Auscultation in resource-limited settings.

Saul G Myerson – 2nd expert on this subject based on the ideXlab platform

  • cardiac Auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients
    Heart, 2018
    Co-Authors: Syed Km Gardezi, Saul G Myerson, Andrew Kennedy, John C Chambers, Sean Coffey, Joanna Darcy, F Richard D Hobbs, Jonathan Holt, Margaret Loudon, Anne Prendergast

    Abstract:

    Objective Cardiac Auscultation is a key clinical skill, particularly for the diagnosis of valvular heart disease (VHD). However, its utility has declined due to the widespread availability of echocardiography and diminishing emphasis on the importance of clinical examination. We aim to determine the contemporary accuracy of Auscultation for diagnosing VHD in primary care. Methods Cardiac Auscultation was undertaken by one of two experienced general practitioners (primary care/family doctors) in a subset of 251 asymptomatic participants aged >65 years undergoing echocardiography within a large community-based screening study of subjects with no known VHD. Investigators were blinded to the echocardiographic findings. Newly detected VHD was classified as mild (mild regurgitation of any valve or aortic sclerosis) or significant (at least moderate regurgitation or mild stenosis of any valve). Results Newly identified VHD was common, with mild disease in 170/251 participants (68%) and significant disease in 36/251 (14%). The sensitivity of Auscultation was low for the diagnosis of mild VHD (32%) but slightly higher for significant VHD (44%), with specificities of 67% and 69%, respectively. Likelihood ratios were not statistically significant for the diagnosis of either mild or significant VHD in the overall cohort, but showed possible value for Auscultation in non-overweight subjects (body mass index 2 ). Conclusion Cardiac Auscultation has limited accuracy for the detection of VHD in asymptomatic patients and is a poor diagnostic screening tool in primary care, particularly for overweight subjects. Ensuring easy access to echocardiography in patients with symptoms suggesting VHD is likely to represent a better diagnostic strategy.

  • 136 gp Auscultation for diagnosing valvular heart disease
    Heart, 2017
    Co-Authors: Saul G Myerson, Bernard Prendergast, Syed Km Gardezi, Anthony Prothero, Andrew Kennedy, Joanna Wilson

    Abstract:

    Introduction Cardiac Auscultation is an important clinical skill used by physicians in assessing and diagnosing valvular heart disease (VHD). The widespread use of echocardiography in the last three decades has coincided with a perceived decline in the utility of Auscultation, particularly by general physicians. The ability of generalists to identify VHD in an unselected population has not been well characterised, so we aimed to determine the accuracy of Auscultation in primary care for diagnosing VHD. Methods 251 participants aged 65 and over who were participating in the OxValve population cohort study were included. They were recruited from two participating GP surgeries and had no previous diagnosis of VHD. The participants underwent cardiac Auscultation during the OxValve study visit by two experienced General Practitioners (GPs), neither of whom had a specialist interest in cardiology. A 5-point Likert scale was used to rate the ability to hear heart sounds (1=not at all; 5=perfectly) in addition to the presence or absence of a murmur, type of murmur and the ability to make a diagnosis based upon the Auscultation findings. This was compared to transthoracic echocardiography performed at the same visit, but GPs were blind to the echocardiogram result, which was performed after Auscultation. VHD was categorised as mild (either mild regurgitation [excluding trace/physiological] or aortic sclerosis) or significant (moderate/severe regurgitation or at least mild stenosis). Standard measures of diagnostic accuracy were calculated. Results 82 murmurs were heard by the GPs (80 systolic; 2 diastolic). Echocardiography identified mild VHD in 174 (69%) of the 251 participants, with more significant VHD present in 37 (15%). The ability to hear a murmur on Auscultation was not related to age, BMI or heart rate (table 1). Auscultation had a sensitivity of 32% and specificity of 67% for diagnosing mild VHD, which improved slightly for significant VHD to a sensitivity of 43%, and specificity of 69% (table 2). The area under the curve on receiver operating characteristics (ROC) analysis was 0.50 for mild VHD and 0.56 for significant VHD (Figure-1) suggesting limited discriminatory ability. Conclusion GP Auscultation has only moderate accuracy for diagnosing valvular heart disease in an unselected population, and the presence of an isolated murmur would not be a reliable indicator of valve disease. This study did not include patients with cardiovascular symptoms however, in whom the presence of a murmur may be more significant, and for whom echocardiography might be more appropriate.

Syed Km Gardezi – 3rd expert on this subject based on the ideXlab platform

  • cardiac Auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients
    Heart, 2018
    Co-Authors: Syed Km Gardezi, Saul G Myerson, Andrew Kennedy, John C Chambers, Sean Coffey, Joanna Darcy, F Richard D Hobbs, Jonathan Holt, Margaret Loudon, Anne Prendergast

    Abstract:

    Objective Cardiac Auscultation is a key clinical skill, particularly for the diagnosis of valvular heart disease (VHD). However, its utility has declined due to the widespread availability of echocardiography and diminishing emphasis on the importance of clinical examination. We aim to determine the contemporary accuracy of Auscultation for diagnosing VHD in primary care. Methods Cardiac Auscultation was undertaken by one of two experienced general practitioners (primary care/family doctors) in a subset of 251 asymptomatic participants aged >65 years undergoing echocardiography within a large community-based screening study of subjects with no known VHD. Investigators were blinded to the echocardiographic findings. Newly detected VHD was classified as mild (mild regurgitation of any valve or aortic sclerosis) or significant (at least moderate regurgitation or mild stenosis of any valve). Results Newly identified VHD was common, with mild disease in 170/251 participants (68%) and significant disease in 36/251 (14%). The sensitivity of Auscultation was low for the diagnosis of mild VHD (32%) but slightly higher for significant VHD (44%), with specificities of 67% and 69%, respectively. Likelihood ratios were not statistically significant for the diagnosis of either mild or significant VHD in the overall cohort, but showed possible value for Auscultation in non-overweight subjects (body mass index 2 ). Conclusion Cardiac Auscultation has limited accuracy for the detection of VHD in asymptomatic patients and is a poor diagnostic screening tool in primary care, particularly for overweight subjects. Ensuring easy access to echocardiography in patients with symptoms suggesting VHD is likely to represent a better diagnostic strategy.

  • 136 gp Auscultation for diagnosing valvular heart disease
    Heart, 2017
    Co-Authors: Saul G Myerson, Bernard Prendergast, Syed Km Gardezi, Anthony Prothero, Andrew Kennedy, Joanna Wilson

    Abstract:

    Introduction Cardiac Auscultation is an important clinical skill used by physicians in assessing and diagnosing valvular heart disease (VHD). The widespread use of echocardiography in the last three decades has coincided with a perceived decline in the utility of Auscultation, particularly by general physicians. The ability of generalists to identify VHD in an unselected population has not been well characterised, so we aimed to determine the accuracy of Auscultation in primary care for diagnosing VHD. Methods 251 participants aged 65 and over who were participating in the OxValve population cohort study were included. They were recruited from two participating GP surgeries and had no previous diagnosis of VHD. The participants underwent cardiac Auscultation during the OxValve study visit by two experienced General Practitioners (GPs), neither of whom had a specialist interest in cardiology. A 5-point Likert scale was used to rate the ability to hear heart sounds (1=not at all; 5=perfectly) in addition to the presence or absence of a murmur, type of murmur and the ability to make a diagnosis based upon the Auscultation findings. This was compared to transthoracic echocardiography performed at the same visit, but GPs were blind to the echocardiogram result, which was performed after Auscultation. VHD was categorised as mild (either mild regurgitation [excluding trace/physiological] or aortic sclerosis) or significant (moderate/severe regurgitation or at least mild stenosis). Standard measures of diagnostic accuracy were calculated. Results 82 murmurs were heard by the GPs (80 systolic; 2 diastolic). Echocardiography identified mild VHD in 174 (69%) of the 251 participants, with more significant VHD present in 37 (15%). The ability to hear a murmur on Auscultation was not related to age, BMI or heart rate (table 1). Auscultation had a sensitivity of 32% and specificity of 67% for diagnosing mild VHD, which improved slightly for significant VHD to a sensitivity of 43%, and specificity of 69% (table 2). The area under the curve on receiver operating characteristics (ROC) analysis was 0.50 for mild VHD and 0.56 for significant VHD (Figure-1) suggesting limited discriminatory ability. Conclusion GP Auscultation has only moderate accuracy for diagnosing valvular heart disease in an unselected population, and the presence of an isolated murmur would not be a reliable indicator of valve disease. This study did not include patients with cardiovascular symptoms however, in whom the presence of a murmur may be more significant, and for whom echocardiography might be more appropriate.