Document Detail


Pre-operative detection of valvular heart disease by anaesthetists.
MedLine Citation:
PMID:  16430564     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We prospectively estimated the prevalence of heart murmurs in 2522 consecutive adult non-cardiac surgery patients during pre-operative evaluation. Factors that contribute to the detection of a heart murmur were identified, and echocardiography was used to evaluate to what extent a murmur reflected presence of valvular heart disease. A cardiac murmur was detected in 106 patients (prevalence 4.2%, 95% CI: 3.5-5.1%). Multivariable logistic regression analyses showed that age and general physical impression were independently associated with detecting a murmur (p-values < 0.01). In 83 (79%) of the patients with a murmur, an echocardiographic diagnosis was available: 39% had aortic valve abnormalities, 24% had mitral valve regurgitation, 7% had other valvular heart disease and 30% did not have any abnormality. Thus, 58 of the 83 patients had valvular heart disease (positive predictive value using routine cardiac auscultation for diagnosing VHD: 70%, 95% CI: 59-79%). Murmurs in patients younger than 40 years never reflected valvular heart disease. Pre-operative cardiac auscultation seems only reasonable in patients aged 40 years or older. Subsequent echocardiography in these selected patients is necessary.
Authors:
W A van Klei; C J Kalkman; M Tolsma; C L G Rutten; K G M Moons
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Anaesthesia     Volume:  61     ISSN:  0003-2409     ISO Abbreviation:  Anaesthesia     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-01-24     Completed Date:  2006-02-13     Revised Date:  2006-07-28    
Medline Journal Info:
Nlm Unique ID:  0370524     Medline TA:  Anaesthesia     Country:  England    
Other Details:
Languages:  eng     Pagination:  127-32     Citation Subset:  AIM; IM    
Affiliation:
University Medical Centre Utrecht, Department Peri-operative Care and Emergency Medicine, PO Box 85500, 3508 GA Utrecht, The Netherlands. w.a.vanklei@umcutrecht.nl
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Anesthesiology / methods
Anthropometry
Aortic Valve Insufficiency / diagnosis
Aortic Valve Stenosis / diagnosis
Female
Health Status Indicators
Heart Auscultation
Heart Murmurs / etiology
Heart Valve Diseases / diagnosis*,  ultrasonography
Humans
Logistic Models
Male
Middle Aged
Mitral Valve Insufficiency / diagnosis
Preoperative Care / methods
Prospective Studies
Comments/Corrections
Comment In:
Anaesthesia. 2006 Jul;61(7):718; author reply 718-9   [PMID:  16792627 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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