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Palpable cardiac impulse predicts adequate acoustic windows
1Section of Cardiology, University of Chicago Hospitals, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
Echocardiography (Mount Kisco, N.Y.)
|September 9, 2000
Summary
Palpating the apical cardiac impulse during physical exams can predict good echocardiographic images for stress echocardiography. This simple physical exam finding helps select the best stress test for patients, improving diagnostic accuracy.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Physical Examination
Background:
- Stress echocardiography is a valuable diagnostic tool.
- Poor image quality is a significant limitation for stress echocardiography.
- Predicting image quality is crucial for appropriate test selection.
Purpose of the Study:
- To evaluate the utility of a palpable apical cardiac impulse in predicting adequate echocardiographic image quality.
- To determine if physical examination can guide the selection of stress echocardiography.
Main Methods:
- 136 outpatients referred for echocardiography were enrolled.
- Two blinded examiners assessed the presence of a palpable cardiac apex.
- Echocardiographic images were scored based on visualized left ventricular wall segments.
Main Results:
- A palpable apex was present in 72% of patients and strongly correlated with adequate image quality (92% vs. 55%, P<0.0001).
- Adequate visualization (≥14/16 segments) was achieved in 82% of patients.
- Multivariate analysis identified a palpable apex as the sole independent predictor of image quality, though higher weight was associated with poorer quality.
Conclusions:
- A palpable apical impulse on physical examination is a useful predictor of adequate echocardiographic image quality for stress echocardiography.
- This physical exam finding can aid in selecting appropriate patients for stress echocardiography.
- Integrating this assessment may optimize referral to stress testing modalities.