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Am Heart J. 2001 Mar;141(3):500-6.

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

Author information

1
New York University School of Medicine, Pediatric Cardiology Program, NYU Medical Center, 540 First Ave., New York, NY 10016, USA. colin.phoon@med.nyu.edu

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.

PMID:
11231450
DOI:
10.1067/mhj.2001.113222
[Indexed for MEDLINE]

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