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Published on: August 8, 2022
Clinical Significance of Physical Examination for Hypertrophic Cardiomyopathy
Tatsuya Kawasaki1, Hirokazu Shiraishi2, Satoaki Matoba2
1Department of Cardiology, Matsushita Memorial Hospital.
Insights
Physical findings like audible S4 are significant indicators for hypertrophic cardiomyopathy (HCM) diagnosis and risk stratification. Their absence predicts adverse cardiovascular events in HCM patients.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Examination
Background:
- Hypertrophic cardiomyopathy (HCM) presents with diverse physical findings.
- The clinical significance of these physical findings in HCM has not been systematically evaluated.
Purpose of the Study:
- To systematically evaluate the clinical significance of physical findings in patients with hypertrophic cardiomyopathy (HCM).
- To assess the diagnostic and prognostic value of specific physical examination findings in HCM.
Main Methods:
- A study involving 105 consecutive HCM patients and 104 controls.
- Physical examinations included assessment for visible jugular a-wave (Jug-a), audible 4th heart sound (S4), and double or sustained apex beat.
- Phonocardiography and external pulse recording were utilized.
Main Results:
- Prevalence of Jug-a, S4, and sustained/double apex beat were significantly higher in HCM patients compared to controls (P<0.001).
- The combination of supine Jug-a and audible S4 showed high specificity (94%) for HCM.
- Absence of audible S4 was a significant predictor of cardiovascular events (HR 3.91, P=0.005) during 6.6 years of follow-up.
Conclusions:
- Physical examination findings like Jug-a and S4 are clinically important for HCM diagnosis.
- These findings aid in the risk stratification of HCM patients, particularly before advanced imaging.
- Audible S4 is a key indicator for prognosis in hypertrophic cardiomyopathy.
Background:
Patients with hypertrophic cardiomyopathy (HCM) show various physical findings, but their clinical significance has not been systematically evaluated.
Methods And Results:
This study evaluated 105 consecutive patients with HCM who had undergone phonocardiography and external pulse recording. Physical examinations included a visible jugular a-wave (Jug-a), audible 4th sound (S4), and double or sustained apex beat. The primary outcome was a composite of all-cause death and hospitalization for cardiovascular disease. A total of 104 non-HCM subjects served as controls. The prevalence of visible Jug-a in the seated or supine position, audible S4, and a sustained or double apex beat in patients with HCM were 10%, 71%, 70%, 42%, and 27%, respectively, all of which were significantly higher than in the controls (0%, 20%, 11%, 17%, and 2%; P<0.001 for all comparisons). The combination of visible Jug-a in the supine position and audible S4 yielded a specificity of 94% and sensitivity of 57%. During a follow-up period of 6.6 years, 6 patients died and 10 were hospitalized. The absence of audible S4 was a predictor of cardiovascular events (hazard ratio, 3.91; 95% confidence interval, 1.41 to 10.8; P=0.005).
Conclusions:
Detection of these findings has clinical importance in the diagnosis and risk stratification of HCM prior to the use of advanced imaging techniques.
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