Objective
To review evidence as to the precision and accuracy
of clinical examination for aortic regurgitation (AR).
Methods
We conducted a structured MEDLINE search of
English-language articles (January 1966-July 1997), manually reviewed
all reference lists of potentially relevant articles, and contacted
authors of relevant studies for additional information. Each study
(n = 16) was independently reviewed by both authors and graded for
methodological quality.
Results
Most studies assessed cardiologists as examiners.
Cardiologists' precision for detecting diastolic murmurs was moderate
using audiotapes (κ=0.51) and was good in the
clinical setting (simple agreement, 94%). The most useful finding for
ruling in AR is the presence of an early diastolic murmur (positive
likelihood ratio [LR], 8.8-32.0 [95% confidence interval {CI},
2.8-32 to 16-63] for detecting mild or greater AR and 4.0-8.3 [95%
CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 grade
A studies). The most useful finding for ruling out AR is the absence of
early diastolic murmur (negative LR, 0.2-0.3 [95% CI, 0.1-0.3 to
0.2-0.4) for mild or greater AR and 0.1 [95% CI, 0.0-0.3] for
moderate or greater AR) (2 grade A studies). Except for a test
evaluating the response to transient arterial occlusion (positive LR,
8.4 [95% CI, 1.3-81.0]; negative LR, 0.3 [95% CI, 0.1-0.8]), most
signs display poor sensitivity and specificity for AR.
Conclusion
Clinical examination by cardiologists is accurate for
detecting AR, but not enough is known about the examinations of
less-expert clinicians.