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Estimation of pressure gradients by auscultation: an innovative and accurate physical examination technique.

Abstract：

BACKGROUND:Knowledge of pressure gradients across valves, arteries, and ventricular septal defects (VSD) is important in patient management. It was determined how well such gradients can be estimated by auscultation of a murmur's frequencies. METHODS:In 151 patients with pulmonary stenosis (PS) (n = 77), aortic stenosis (AS) (n = 30), or VSD (n = 44), the auscultation gradient was estimated by a murmur's frequencies by use of an "auscultatory scale." The auscultation gradient was recorded before Doppler echocardiography was performed by a blinded cardiac sonographer. RESULTS:Auscultation correlated highly with Doppler echocardiography (Doppler = 0.99. Auscultation + 7.12; r = 0.84, P <.0001). Agreement was good (mean difference [Auscultation - Doppler] = -6.8 +/- 15.8 mm Hg). In 95 patients (63%), agreement was within 10 mm Hg. Auscultation was more accurate when Doppler gradients were < or =60 mm Hg (r = 0.76, P <.0001, vs r = 0.22, P not significant for >60 mm Hg; mean difference -2.6 +/- 10.6 mm Hg vs -16.5 +/- 20.9 mm Hg for >60 mm Hg, P <.0001). Among lesions, PS showed the highest correlation, although agreement for PS, AS, and VSD was not significantly different. Isolated valvar PS showed excellent accuracy (r = 0.92, P <.0001; mean difference -5.6 +/- 8.9 mm Hg). CONCLUSIONS:Auscultation of a murmur's frequency composition can estimate gradients accurately in most patients with PS (especially valvar PS), AS, or VSD, although it is less accurate for gradients >60 mm Hg. This innovative technique can improve diagnostic accuracy, thereby further substantiating the value of physical examination.

journal_name

Am Heart J

journal_title

American heart journal

authors

Phoon CK

doi

10.1067/mhj.2001.113222

subject

Has Abstract

pub_date

2001-03-01 00:00:00

pages

500-6

issue

3

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(01)27522-X

journal_volume

141

pub_type

杂志文章

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