Systolic Ejection Click vs. Split First Heart Sound: Are Our Ears Deceiving Us? Público

Abstract

Objective
Bicuspid aortic valve disease is associated with lifetime complications, but auscultation of this subtle pathology is commonly missed or mistaken for a benign split first heart sound. The authors sought to determine whether pediatric cardiologists could distinguish between bicuspid aortic valves and split first heart sounds.

Design

Quality evaluation project using de-identified recordings from Sibley Heart Center clinic patients, Atlanta, GA.

Outcome Measures

21 cardiologists listened to 5 recordings of pediatric heart sounds and indicated whether each recording was a bicuspid valve or split heart sound. 3 had the systolic ejection click of bicuspid aortic valves, and 2 contained mitral components of split first heart sounds. We determined accuracy of diagnoses using percent agreement and calculated kappa coefficients for the cohort and subgroups based on those with <10 years of experience vs. those with ≥10 years. To access precision, we used a Kappa extension for multiple raters to assess interrater agreement among the 21 cardiologists.

Results

Among participants, diagnostic accuracy of bicuspid aortic valves was 38%, while accuracy of split first heart sound was 41%. No participant correctly diagnosed all sounds. No difference in agreement was observed when stratifying by experience. Kappa was -0.11 (CI 95% -0.31-0.08) for all raters, -0.03 (CI 95% -0.39-0.33) for those with <10 years' experience, and -0.15 (CI 95% -0.38-0.08) for those with >10 years' experience. The Kappa statistic among the 21 raters was 0.01 (95% CI -0.03 - 0.04), indicating poor precision among the raters.

Conclusions

In this sample of pediatric cardiologists, the diagnostic accuracy of bicuspid atrial valves vs split first heart sounds was worse than chance. There was no association between years of experience and diagnostic accuracy. While further study is needed, these data suggest that an echocardiogram may be valuable when either a systolic ejection click or split first heart sound is heard.

Table of Contents

Table of Contents

Page #

Introduction 1

Methods 2-3

Results 4

Discussion 5-7

References 8-10

Tables 11

Figures 12

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Palabra Clave	Auscultation Quality Bicuspid Aortic Valve Echocardiography
Committee Chair / Thesis Advisor	Oster, Matthew E, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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