title: Comprehensive evaluation of the apex beat using 64-slice computed tomography: Impact of left ventricular mass and distance to chest wall.
abstract: OBJECTIVE
  Although physicians frequently perform palpation of the apex beat to evaluate left ventricular (LV) size and hypertrophy, the clinical significance of apex beat palpation is still unclear. The introduction of multislice computed tomography (MSCT) has enabled assessment not only of coronary stenoses but also LV volume, mass, and distance from heart to chest wall. The aim of this study was to evaluate the relationships among presence, location, and sustained or double apical impulse of apex beat and LV function, volume, mass, and distance from heart to chest wall determined by MSCT.
  
  
  RESULTS
  The study population consisted of 200 consecutive patients clinically indicated for MSCT angiography for coronary artery evaluation. Apex palpation was performed with the patients in the supine and left lateral decubitus positions. Multivariate analysis revealed that LV mass index (p<0.01), distance (p<0.005), and being male (p<0.005) remained independent factors associated with presence of apex beat in the supine position, and that LV mass index was also associated with location of apex beat. Furthermore, in patients with a palpable apex beat, LV mass index was an independent factor associated with patterns of sustained or double apical impulse. In the group of all patients, patterns of sustained or double apical impulse in the supine position had a sensitivity of 57%, specificity of 90%, positive predictive value of 68%, and negative predictive value of 85% as an indicator of LV hypertrophy.
  
  
  CONCLUSIONS
  Palpation of the apex beat is a sensitive diagnostic maneuver for excluding patients with increased LV mass. We believe that our observations have important implications for bedside clinical examination.
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. ehara@med.osaka-cu.ac.jp
authors.forename: Shoichi
authors.initials: S
authors.lastname: Ehara
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Okuyama
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shirai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Oe
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugioka
authors.forename: Toshihide
authors.initials: T
authors.lastname: Itoh
authors.forename: Katharina
authors.initials: K
authors.lastname: Otani
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hozumi
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
authors.forename: Junichi
authors.initials: J
authors.lastname: Yoshikawa
mesh_terms: D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D007702:Kinetocardiography; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D012737:Sex Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016277:Ventricular Function, Left