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Diagnostic accuracy of a displaced apical impulse for detecting ventricular enlargement in infants
Amal Mohan1, Dinesh Kumar Yadav1, Dheeraj Deo Bhatt1
1Department of Pediatrics, Division of Pediatric Cardiology, Atal Bihari Vajpayee Institute of Medical Sciences & Dr Ram Manohar Lohia Hospitalhttps://ror.org/00qa63322, India.
Insights
Palpating the apical impulse, a key cardiac exam step, can help detect left ventricular enlargement in infants. A horizontal displacement of 4 cm or more from the mid-sternal line is a simple, accurate indicator.
Area of Science:
- Pediatric Cardiology
- Diagnostic Accuracy
- Cardiac Physical Examination
Background:
- Apical impulse palpation is crucial for assessing ventricular size and function.
- The diagnostic accuracy of apical impulse palpation for cardiac enlargement in infants was previously unknown.
Purpose of the Study:
- To evaluate the diagnostic accuracy of apical impulse palpation in detecting left ventricular enlargement in infants.
- To determine a reliable method for identifying cardiac enlargement through physical examination.
Main Methods:
- A cross-sectional observational study involving 309 infants aged 1 month to 1 year.
- Apical impulse location (intercostal space, distance from mid-sternal line) was recorded.
- Echocardiography was used as the reference standard to assess cardiac chamber enlargement (Z score > 2).
Main Results:
- A displaced apical impulse showed a diagnostic accuracy of 71.5%.
- Defining displaced apical impulse as horizontal displacement > 4 cm from the mid-sternal line improved accuracy to 79.0%.
- This definition yielded a sensitivity of 76.4% and specificity of 81.1%.
Conclusions:
- Horizontal displacement of the apical impulse ≥ 4 cm from the mid-sternal line is a simple and accurate method for identifying left ventricular enlargement in infants.
- This physical examination technique can aid in early detection of cardiac abnormalities in pediatric populations.
Background:
The apical impulse palpation is a key component of cardiac physical examination, which offers insights into ventricular size and function. Its diagnostic accuracy in detecting cardiac enlargement in infants is unknown.
Methods:
This cross-sectional observational study was done in infants 1 month to 1 year of age visiting a tertiary care hospital. The apical impulse was palpated and marked in supine position and its location in terms of the intercostal space and distance from mid-sternal line was noted. Echocardiography was performed to assess cardiac chamber enlargement. Z score of echo parameters was calculated. z score > 2 was considered to be an enlarged cardiac chamber. The diagnostic accuracy of a displaced apical impulse in detecting ventricular enlargement was evaluated using echocardiography as the reference standard.
Results:
309 infants were enrolled in the study. 22 % of the study subjects had a structurally normal heart. A displaced apical impulse had a diagnostic accuracy of 71.5%. Using another definition to define a displaced apical impulse, namely, horizontal displacement of > 4 cm from the mid-sternal line (regardless of the level of intercostal space), increased the diagnostic accuracy to 79.0 % with sensitivity and specificity of 76.4% and 81.1 %, respectively.
Conclusion:
Horizontal displacement of the apical impulse 4 cm or more from the mid-sternal line (regardless of the level of intercostal space) is a simple and fairly accurate method to identify left ventricular enlargement in infants.
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