Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review

Background: Handheld echocardiography is being proposed as the fifth pillar of bedside physical cardiovascular examination (PE) and is referred to as insonation. Although there is emerging consensus that insonation is superior to PE for diagnosis of various cardiac conditions, superiority has not be...

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Autores principales:	Dylan Stanger, Darryl Wan, Nima Moghaddam, Niki Elahi, Edgar Argulian, Jagat Narula, Amir Ahmadi
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2019
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/abc83e4a94114149aec2101724391b80
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spelling	oai:doaj.org-article:abc83e4a94114149aec2101724391b802021-12-02T03:32:04ZInsonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review2214-999610.5334/aogh.2489https://doaj.org/article/abc83e4a94114149aec2101724391b802019-07-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/2489https://doaj.org/toc/2214-9996Background: Handheld echocardiography is being proposed as the fifth pillar of bedside physical cardiovascular examination (PE) and is referred to as insonation. Although there is emerging consensus that insonation is superior to PE for diagnosis of various cardiac conditions, superiority has not been consistently demonstrated for various valvular heart disease (VHD) lesions. The objective of this review is to systematically review the accuracy of insonation and auscultation in published literature for detection of common VHD. Methods: An extensive literature search across three commonly used public databases allowed comparison of diagnostic characteristics of insonation and auscultation for common VHD including aortic stenosis, mitral regurgitation, aortic regurgitation, tricuspid regurgitation. Sensitivity, specificity, and accuracy of insonation and auscultation for the detection of these VHD lesions were extracted for further analysis. The quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: Eight hundred eighty studies were screened, and seven observational studies were selected for full analysis. Due to heterogeneity of data, this study was not amenable to meta-analysis. Insonation was superior to auscultation for the detection of all regurgitant lesions, but there was no significant difference in diagnostic ability of the two strategies for detection of aortic stenosis. Conclusions: Compared to auscultation, insonation, in its currently available form, is a superior diagnostic tool for regurgitant lesions. However, insonation fails to improve upon auscultation for recognition of aortic stenosis. This limitation is likely due to absence of spectral Doppler and inability of HE to assess transvalvular velocity and gradient.Dylan StangerDarryl WanNima MoghaddamNiki ElahiEdgar ArgulianJagat NarulaAmir AhmadiUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 85, Iss 1 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Dylan Stanger Darryl Wan Nima Moghaddam Niki Elahi Edgar Argulian Jagat Narula Amir Ahmadi Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review
description	Background: Handheld echocardiography is being proposed as the fifth pillar of bedside physical cardiovascular examination (PE) and is referred to as insonation. Although there is emerging consensus that insonation is superior to PE for diagnosis of various cardiac conditions, superiority has not been consistently demonstrated for various valvular heart disease (VHD) lesions. The objective of this review is to systematically review the accuracy of insonation and auscultation in published literature for detection of common VHD. Methods: An extensive literature search across three commonly used public databases allowed comparison of diagnostic characteristics of insonation and auscultation for common VHD including aortic stenosis, mitral regurgitation, aortic regurgitation, tricuspid regurgitation. Sensitivity, specificity, and accuracy of insonation and auscultation for the detection of these VHD lesions were extracted for further analysis. The quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: Eight hundred eighty studies were screened, and seven observational studies were selected for full analysis. Due to heterogeneity of data, this study was not amenable to meta-analysis. Insonation was superior to auscultation for the detection of all regurgitant lesions, but there was no significant difference in diagnostic ability of the two strategies for detection of aortic stenosis. Conclusions: Compared to auscultation, insonation, in its currently available form, is a superior diagnostic tool for regurgitant lesions. However, insonation fails to improve upon auscultation for recognition of aortic stenosis. This limitation is likely due to absence of spectral Doppler and inability of HE to assess transvalvular velocity and gradient.
format	article
author	Dylan Stanger Darryl Wan Nima Moghaddam Niki Elahi Edgar Argulian Jagat Narula Amir Ahmadi
author_facet	Dylan Stanger Darryl Wan Nima Moghaddam Niki Elahi Edgar Argulian Jagat Narula Amir Ahmadi
author_sort	Dylan Stanger
title	Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review
title_short	Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review
title_full	Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review
title_fullStr	Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review
title_full_unstemmed	Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review
title_sort	insonation versus auscultation in valvular disorders: is aortic stenosis the exception? a systematic review
publisher	Ubiquity Press
publishDate	2019
url	https://doaj.org/article/abc83e4a94114149aec2101724391b80
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Insonation versus Auscultation in Valvular Disorders: Is Aortic Stenosis the Exception? A Systematic Review

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