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. 1999 Feb;137(2):298-306.
doi: 10.1053/hj.1999.v137.95496.

Physical examination in valvular aortic stenosis: correlation with stenosis severity and prediction of clinical outcome

B Munt  1 , M E Legget, C D Kraft, C Y Miyake-Hull, M Fujioka, C M Otto
Affiliations

Physical examination in valvular aortic stenosis: correlation with stenosis severity and prediction of clinical outcome

B Munt et al. Am Heart J. 1999 Feb.

Abstract

Background and methods: The goal of this study was to examine the ability of physical examination to predict valvular aortic stenosis severity and clinical outcome in 123 initially asymptomatic subjects (mean age 63 +/- 16 years, 70% men) followed up for a mean of 2.5 +/- 1.4 years.

Results: Doppler aortic jet velocity correlated with systolic murmur intensity (P =.003) and timing (P =.0002), a single second heart sound (P =.01), and carotid upstroke delay (P <.0001) and amplitude (P <.0001). However, no physical examination findings had both a high sensitivity and a high specificity for the diagnosis of severe valvular obstruction. Clinical end points were reached in 56 subjects (46%), including 8 deaths and 48 valve replacements for symptom onset. Univariate predictors of outcome included carotid upstroke delay (P =.0008) and amplitude (P =.0006), systolic murmur grade (P <.0001) and peak (P =.0003), and a single second heart sound (P =.003). On multivariate Cox regression analysis, the only physical examination predictor of outcome was carotid upstroke amplitude (P =.0001).

Conclusions: Although physical examination findings correlate with stenosis severity, echocardiography still is needed to exclude severe obstruction reliably when this diagnosis is suspected.

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