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

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


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.

MeSH terms

  • Aortic Valve Stenosis / diagnosis*
  • Aortic Valve Stenosis / epidemiology
  • Aortic Valve Stenosis / surgery
  • Echocardiography, Doppler
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation
  • Humans
  • Male
  • Middle Aged
  • Physical Examination*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Sensitivity and Specificity
  • Time Factors