Dataset Information

Bedside Physical Examination for the Diagnosis of Aortic Stenosis: A Systematic Review and Meta-analysis.

ABSTRACT:

Background

Patients with obstruction to the left ventricular outflow tract from degenerative aortic stenosis (AS) usually do not become symptomatic until their disease becomes graded as severe. We sought to assess the accuracy of the physical examination for the diagnosis of AS of at least moderate severity.

Methods

A systematic review and meta-analysis of case series and cohorts of patients who received a cardiovascular physical examination prior to receiving a left heart catheterization or an echocardiogram. PubMed, Ovid MEDLINE, the Cochrane Library, ClinicalTrials.gov, and Embase were searched with a date range from inception through December 10, 2021, without language restrictions.

Results

Our systematic review yielded 7 observational studies with adequate data to perform a meta-analysis on 3 physical examination assessments. Auscultating a diminished second heart sound (likelihood ratio [LR] = 10.87, 95% confidence interval [CI], 3.94-30.12, P < 0.05) and palpating a delayed carotid upstroke (LR = 9.04, 95% CI, 3.12-25.44, P < 0.05) are useful for detecting AS of at least moderate severity. The absence of a systolic murmur radiating to the neck (LR = 0.11, 95% CI, 0.06-0.23, P < 0.05) rules against AS of at least moderate severity.

Conclusions

Low-quality evidence from observational studies supports a diminished second heart sound and a delayed carotid upstroke as having moderate accuracy in diagnosing the presence of AS of at least moderate severity, whereas the absence of a murmur radiating to the neck is equally accurate in excluding this diagnosis.

SUBMITTER: Shellenberger RA

PROVIDER: S-EPMC10290951 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Bedside Physical Examination for the Diagnosis of Aortic Stenosis: A Systematic Review and Meta-analysis.

Shellenberger Richard A RA Crass Stephanie S Jevicks Justin J Badhwar Ankita A Albright Jeremy J Kumar Agara A

CJC open 20230227 5

<h4>Background</h4>Patients with obstruction to the left ventricular outflow tract from degenerative aortic stenosis (AS) usually do not become symptomatic until their disease becomes graded as severe. We sought to assess the accuracy of the physical examination for the diagnosis of AS of at least moderate severity.<h4>Methods</h4>A systematic review and meta-analysis of case series and cohorts of patients who received a cardiovascular physical examination prior to receiving a left heart cathete ...[more]

PMID: 37377515

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Project description:ObjectiveWe sought to conduct a systematic review and meta-analysis of clinical adverse events in patients undergoing transcatheter aortic valve replacement (TAVR) with bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) anatomy and the efficacy of balloon-expandable (BE) vs. self-expanding (SE) valves in the BAV population. Comparisons aforementioned will be made stratified into early- and new-generation devices. Differences of prosthetic geometry on CT between patients with BAV and TAV were presented. In addition, BAV morphological presentations in included studies were summarized.MethodObservational studies and a randomized controlled trial of patients with BAV undergoing TAVR were included according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.ResultsA total of 43 studies were included in the final analysis. In patients undergoing TAVR, type 1 BAV was the most common phenotype and type 2 BAV accounted for the least. Significant higher risks of conversion to surgical aortic valve replacement (SAVR), the need of a second valve, a moderate or severe paravalvular leakage (PVL), device failure, acute kidney injury (AKI), and stroke were observed in patients with BAV than in patients with TAV during hospitalization. BAV had a higher risk of new permanent pacemaker implantation (PPI) both at hospitalization and a 30-day follow-up. Risk of 1-year mortality was significantly lower in patients with BAV than that with TAV [odds ratio (OR) = 0.85, 95% CI 0.75-0.97, p = 0.01]. BE transcatheter heart valves (THVs) had higher risks of annular rupture but a lower risk of the need of a second valve and a new PPI than SE THVs. Moreover, BE THV was less expanded and more elliptical in BAV than in TAV. In general, the rates of clinical adverse events were lower in new-generation THVs than in early-generation THVs in both BAV and TAV.ConclusionsDespite higher risks of conversion to SAVR, the need of a second valve, moderate or severe PVL, device failure, AKI, stroke, and new PPI, TAVR seems to be a viable option for selected patients with severe bicuspid aortic stenosis (AS), which demonstrated a potential benefit of 1-year survival, especially among lower surgical risk population using new-generation devices. Larger randomized studies are needed to guide patient selection and verified the durable performance of THVs in the BAV population.

Project description:AimsAortic stenosis (AS) and cardiac amyloidosis (CA) are typical diseases of the elderly. Up to 16% of older adults with severe AS referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. CA-AS population suffers from reduced functional capacity and worse prognosis than AS patients. As the prognostic impact of TAVR in patients with CA-AS has been historically questioned and in light of recently published evidence, we aim to provide a comprehensive synthesis of the efficacy and safety of TAVR in CA-AS patients.Methods and resultsWe performed a systematic review and meta-analysis of studies: (i) evaluating mortality with TAVR as compared with medical therapy in CA-AS patients and (ii) reporting complications and clinical outcomes of TAVR in CA-AS patients as compared with patients with AS alone. A total of seven observational studies were identified: four reported mortality with TAVR, and four reported complications and clinical outcomes after TAVR of patients with CA-AS compared with AS alone patients. In patients with CA-AS, the risk of mortality was lower with TAVR (n = 44) as compared with medical therapy (n = 36) [odds ratio (OR) 0.23, 95% confidence interval (CI) 0.07-0.73, I2 = 0%, P = 0.001, number needed to treat = 3]. The safety profile of TAVR seems to be similar in patients with CA-AS (n = 75) as compared with those with AS alone (n = 536), with comparable risks of stroke, vascular complications, life-threatening bleeding, acute kidney injury, and 30 day mortality, although CA-AS was associated with a trend towards an increased risk of permanent pacemaker implantation (OR 1.76, 95% CI 0.91-4.09, I2 = 0%, P = 0.085). CA is associated with a numerically higher rate of long-term mortality and rehospitalizations following TAVR in patients with CA-AS as compared with those with AS alone.ConclusionsTAVR is an effective and safe procedure in CA-AS patients, with a substantial survival benefit as compared with medical therapy, and a safety profile comparable with patients with AS alone except for a trend towards higher risk of permanent pacemaker implantation.

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Dataset Information

Bedside Physical Examination for the Diagnosis of Aortic Stenosis: A Systematic Review and Meta-analysis.

Background

Methods

Results

Conclusions

Publications

Bedside Physical Examination for the Diagnosis of Aortic Stenosis: A Systematic Review and Meta-analysis.

Similar Datasets

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