Physical examination in aortic stenosis. Correlation with echocardiographic and peripheral Doppler echocardiography findings

Abstract

Introduction and objectivesPhysical examination is useful for detecting cardiac murmurs in patients with suspected aortic stenosis (AS). Our aim was to evaluate the correlation between physical findings, peripheral artery Doppler, and the echocardiographic parameters of severity in patients with AS. MethodsBetween August 2017 and January 2018, patients diagnosed with AS (peak velocity >2.5m/s) were prospectively included, and classified into severe (effective orifice area [EOA] <1cm2) and non-severe AS (EOA ≥1cm2). A cardiologist, blinded to the echocardiographic findings, performed a complete physical examination, and then another cardiologist, blinded to previous data, examined the patients to evaluate interobserver variability. A brachial artery Doppler was also performed. ResultsEighty-six patients were included (mean age 76±9 years, 48% women), of which 49 (57%) had non-severe, and 37 (43%) severe AS. Murmur intensity (r=−0.32; P=.003) and duration (r=−0.54; P<.001) correlated with EOA. Absence of second heart sound was the parameter with higher AUC=0.85; P<.001), late-systole murmur duration (AUC=0.79, P<.001) and pulsus tardus ≥2 (AUC=0.77, P<.001) for severe AS. A cut-off value of 84ms in acceleration time in brachial artery had a sensitivity of 46%, specificity of 87% for severe AS. ConclusionsPhysical examination findings have an acceptable diagnostic accuracy for assessing AS severity. Prolongation of acceleration time in brachial artery could help assessing AS severity.