Document Detail


Relationship between accurate auscultation of a clinically useful third heart sound and level of experience.
MedLine Citation:
PMID:  16567599     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Poor performance by physicians-in-training and interobserver variability between physicians have diminished clinicians' confidence in the value of the third heart sound (S3). METHODS: To determine whether auscultation of a clinically useful S3 improves with advancing levels of experience, we performed a prospective, blinded, observational study of 100 patients undergoing left-sided heart catheterization. Patients underwent blinded auscultation by 4 physicians (each from 1 of 4 different levels of experience), phonocardiography, measurement of blood B-type natriuretic peptide levels, echocardiography for measurement of left ventricular ejection fraction, and cardiac catheterization for measurement of left ventricular end-diastolic pressure. RESULTS: Whereas residents' and interns' auscultatory findings demonstrated no significant agreement with phonocardiographic findings, an S3 auscultated by cardiology fellows (kappa = 0.37; P<.001) and cardiology attendings (kappa = 0.29; P = .003) agreed with phonocardiographic findings. Although the sensitivities of the S3 were low (13%-52%) for identifying patients with abnormal measures of left ventricular function, the specificities were high (85%-95%), with the best test characteristics exhibited by phonocardiography and more experienced physicians. The S3 detected by attendings and fellows was superior in distinguishing an elevated B-type natriuretic peptide level, a depressed left ventricular ejection fraction, or an elevated left ventricular end-diastolic pressure (P = .002-.02 for attendings and .02-.03 for fellows) compared with residents (P = .02-.47) or interns (P = .09-.64). CONCLUSIONS: The S3 auscultated by more experienced physicians demonstrated fair agreement with phonocardiographic findings. Although correlations were superior for phonocardiography, the associations between the S3 and abnormal markers of left ventricular function improved with each level of auscultator experience.
Authors:
Gregory M Marcus; Gregory Marcus; Joshua Vessey; Mark V Jordan; Michele Huddleston; Barry McKeown; Ivor L Gerber; Elyse Foster; Kanu Chatterjee; Charles E McCulloch; Andrew D Michaels
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  166     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-03-28     Completed Date:  2006-04-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  617-22     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of California, San Francisco 94143-0124, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cardiology / education
Clinical Competence*
Diagnosis, Computer-Assisted
Diastole / physiology
Echocardiography
Female
Heart Catheterization
Heart Sounds*
Humans
Internship and Residency
Male
Middle Aged
Natriuretic Peptide, Brain / blood
Phonocardiography*
Physicians
Prospective Studies
San Francisco
Sensitivity and Specificity
Stroke Volume / physiology
Ventricular Dysfunction, Left / blood,  diagnosis*,  physiopathology
Chemical
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain
Comments/Corrections
Comment In:
Arch Intern Med. 2006 Mar 27;166(6):603-4   [PMID:  16567596 ]
Erratum In:
Arch Intern Med. 2006 Jun 12;166(11):1217
Note: Marcus, Gregory [corrected to Marcus, Gregory M]

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


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