title: Pre-operative detection of valvular heart disease by anaesthetists.
abstract: 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.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
authors.forename: W A
authors.initials: WA
authors.lastname: van Klei
authors.forename: C J
authors.initials: CJ
authors.lastname: Kalkman
authors.forename: M
authors.initials: M
authors.lastname: Tolsma
authors.forename: C L G
authors.initials: CL
authors.lastname: Rutten
authors.forename: K G M
authors.initials: KG
authors.lastname: Moons
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000776:Anesthesiology / Q000379:methods; D000886:Anthropometry; D001022:Aortic Valve Insufficiency / Q000175:diagnosis; D001024:Aortic Valve Stenosis / Q000175:diagnosis; D005260:Female; D006305:Health Status Indicators; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000209:etiology; D006349:Heart Valve Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D014463:Ultrasonography