Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review
Objective The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.Design/methods A systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiog...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-03-01
|
| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/3/e068121.full |
| _version_ | 1827867354902560768 |
|---|---|
| author | Henrik Schirmer Hasse Melbye Eirik Reierth Peder Andreas Halvorsen Anne Herefoss Davidsen Stian Andersen |
| author_facet | Henrik Schirmer Hasse Melbye Eirik Reierth Peder Andreas Halvorsen Anne Herefoss Davidsen Stian Andersen |
| author_sort | Henrik Schirmer |
| collection | DOAJ |
| description | Objective The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.Design/methods A systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiography, to evaluate VHD in adults, was performed in MEDLINE (1947–November 2021) and EMBASE (1947–November 2021). Two reviewers screened all references by title and abstract, to select studies to be included. Disagreements were resolved by consensus meetings. Reference lists of included studies were also screened. The results are presented as a narrative synthesis, and risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2.Main outcome measures Sensitivity, specificity and likelihood ratios (LRs).Results We found 23 articles meeting the inclusion criteria. Auscultation was compared with full echocardiography in 15 of the articles; pulsed Doppler was used as reference standard in 2 articles, while aortography and ventriculography was used in 5 articles. One article used point-of-care ultrasound. The articles were published from year 1967 to 2021. Sensitivity of auscultation ranged from 30% to 100%, and specificity ranged from 28% to 100%. LRs ranged from 1.35 to 26. Most of the included studies used cardiologists or internal medicine residents or specialists as auscultators, whereas two used general practitioners and two studied several different auscultators.Conclusion Sensitivity, specificity and LRs of auscultation varied considerably across the different studies. There is a sparsity of data from general practice, where auscultation of the heart is usually one of the main methods for detecting VHD. Based on this review, the diagnostic utility of auscultation is unclear and medical doctors should not rely too much on auscultation alone. More research is needed on how auscultation, together with other clinical findings and history, can be used to distinguish patients with VHD.PROSPERO registration number CRD42018091675. |
| first_indexed | 2024-03-12T15:16:33Z |
| format | Article |
| id | doaj.art-ff5c60e434c64b4e8e4f9076f6169cdf |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T15:16:33Z |
| publishDate | 2023-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-ff5c60e434c64b4e8e4f9076f6169cdf2023-08-11T13:20:07ZengBMJ Publishing GroupBMJ Open2044-60552023-03-0113310.1136/bmjopen-2022-068121Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic reviewHenrik Schirmer0Hasse Melbye1Eirik Reierth2Peder Andreas Halvorsen3Anne Herefoss Davidsen4Stian Andersen5Department of Clinical Medicine, University of Oslo Faculty of Medicine, Lørenskog, NorwayGeneral Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, NorwayScience and Health Library, UiT The Arctic University, Tromso, Troms, NorwayGeneral Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, NorwayGeneral Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, NorwayGeneral Practice Research Unit, Department of Community Medicine, UiT The Arctic University, Tromso, NorwayObjective The objective of this study was to determine the diagnostic accuracy in detecting valvular heart disease (VHD) by heart auscultation, performed by medical doctors.Design/methods A systematic literature search for diagnostic studies comparing heart auscultation to echocardiography or angiography, to evaluate VHD in adults, was performed in MEDLINE (1947–November 2021) and EMBASE (1947–November 2021). Two reviewers screened all references by title and abstract, to select studies to be included. Disagreements were resolved by consensus meetings. Reference lists of included studies were also screened. The results are presented as a narrative synthesis, and risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2.Main outcome measures Sensitivity, specificity and likelihood ratios (LRs).Results We found 23 articles meeting the inclusion criteria. Auscultation was compared with full echocardiography in 15 of the articles; pulsed Doppler was used as reference standard in 2 articles, while aortography and ventriculography was used in 5 articles. One article used point-of-care ultrasound. The articles were published from year 1967 to 2021. Sensitivity of auscultation ranged from 30% to 100%, and specificity ranged from 28% to 100%. LRs ranged from 1.35 to 26. Most of the included studies used cardiologists or internal medicine residents or specialists as auscultators, whereas two used general practitioners and two studied several different auscultators.Conclusion Sensitivity, specificity and LRs of auscultation varied considerably across the different studies. There is a sparsity of data from general practice, where auscultation of the heart is usually one of the main methods for detecting VHD. Based on this review, the diagnostic utility of auscultation is unclear and medical doctors should not rely too much on auscultation alone. More research is needed on how auscultation, together with other clinical findings and history, can be used to distinguish patients with VHD.PROSPERO registration number CRD42018091675.https://bmjopen.bmj.com/content/13/3/e068121.full |
| spellingShingle | Henrik Schirmer Hasse Melbye Eirik Reierth Peder Andreas Halvorsen Anne Herefoss Davidsen Stian Andersen Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review BMJ Open |
| title | Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review |
| title_full | Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review |
| title_fullStr | Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review |
| title_full_unstemmed | Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review |
| title_short | Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review |
| title_sort | diagnostic accuracy of heart auscultation for detecting valve disease a systematic review |
| url | https://bmjopen.bmj.com/content/13/3/e068121.full |
| work_keys_str_mv | AT henrikschirmer diagnosticaccuracyofheartauscultationfordetectingvalvediseaseasystematicreview AT hassemelbye diagnosticaccuracyofheartauscultationfordetectingvalvediseaseasystematicreview AT eirikreierth diagnosticaccuracyofheartauscultationfordetectingvalvediseaseasystematicreview AT pederandreashalvorsen diagnosticaccuracyofheartauscultationfordetectingvalvediseaseasystematicreview AT anneherefossdavidsen diagnosticaccuracyofheartauscultationfordetectingvalvediseaseasystematicreview AT stianandersen diagnosticaccuracyofheartauscultationfordetectingvalvediseaseasystematicreview |