Audiocardiography in the cardiovascular evaluation of the morbidly obese.
Morbid obesity is believed to limit cardiovascular auscultation. We compared audiocardiography to senior attending physicians using conventional stethoscopes in 190 individuals with morbid obesity. Overall, there were 128 (67.4%) women and 62 (32.6%) men with mean ages of 44.9 +/- 12.3 and 51.3 +/- 10.8 , respectively (P = 0.001). The overall body mass index (BMI) was 47.3 +/- 8.5 kg m(-2). Of those with an S(3) by audiocardiography (n = 7), one had a history of coronary artery disease (CAD), none had a history of heart failure, and one had a left ventricular ejection fraction (LVEF) <45%. The mean LVEF was 58.6 +/- 9.9 versus 61.6 +/- 5.3 for those with and without an S(3) by audiocardiography (P = 0.16). By contrast, of those (n = 6) with an S(3) by stethoscope, one had a history of CAD, two had histories of heart failure, and 3 had LVEF < 45%. The mean LVEF of those with and without S(3) by stethoscope was 53.7 +/- 2.3 and 61.6 +/- 5.5%, respectively (P = 0.02). There were 40 (21.1%) patients with an S(4) (S(4) strength >5) identified by acoustic cardiography while there were 42 (22.1%) heard by the stethoscope and it was heard with both methods in nine patients (21.4% concordance). There were no significant correlations between BMI or peak oxygen consumption and S(3) or S(4) strength by audiocardiography. Acoustic cardiography performed with an electronic device was not helpful in assisting the cardiovascular examination of the morbidly obese. These data suggest the careful clinical exam with attention to traditional cardiac auscultation using a stethoscope in a quiet room should remain the gold standard.
McCullough
Peter A
PA
Department of Medicine, Division of Nutrition and Preventive Medicine, William Beaumont Hospital.
Zerka
Melissa
M
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Heimbach
Esther
E
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Musialcyzk
Maria
M
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Spring
Thomas
T
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
DeJong
Adam
A
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Jafri
Syed S
SS
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Coleman
Catherine
C
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Washington
Tamika
T
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Raheem
Shaheena
S
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Vanhecke
Thomas
T
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
Zalesin
Kerstyn C
KC
Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006326:Heart Auscultation / Q000295:instrumentation; D006339:Heart Rate; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000503:physiopathology; D010701:Phonocardiography / Q000295:instrumentation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D019023:Stethoscopes; D013318:Stroke Volume; D016277:Ventricular Function, Left