Screening for aortic stenosis using physical examination and echocardiography.

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Medicine

Background:

• Aortic stenosis (AS) requires timely diagnosis for effective treatment with surgical aortic valve replacement or transcatheter aortic valve implantation.
• Systolic ejection murmurs (SEM) are initial indicators of AS but are common and non-specific, leading to overuse of costly echocardiograms.
• Current screening methods for AS often rely on subjective visual assessment, necessitating more objective approaches.

Purpose of the Study:

• To review and discuss the combined use of physical examinations and focused cardiac ultrasound (FoCUS) for the early and accurate screening of significant aortic stenosis (AS).
• To highlight the utility of objective FoCUS parameters, such as AS and calcification scores, in identifying patients who require further echocardiographic evaluation.

Main Methods:

• Review of existing literature on screening for valvular heart disease using focused cardiac ultrasound (FoCUS).
• Emphasis on objective assessment parameters including visual AS and calcification scores in FoCUS.
• Discussion of integrating physical examination findings with FoCUS results for improved diagnostic accuracy.

Main Results:

• Combining physical examination with a SEM can help rule out a proportion of normal cases without missing severe AS.
• Objective FoCUS scores (AS and calcification) are effective in screening for AS.
• Patients with severe AS or high event probability are unlikely to be overlooked if referred for standard echocardiography based on FoCUS scores of 3 or more.

Conclusions:

• A combined approach of physical examination and FoCUS offers an efficient and objective method for screening significant AS.
• Objective FoCUS parameters improve the reliability of screening, reducing the need for universal echocardiography in patients with SEM.
• This strategy ensures timely referral for definitive diagnosis and treatment, particularly for elderly patients with non-specific murmurs.