Etchells et al reported a bedside clinical prediction rule for detecting significant aortic stenosis in a patient. This can help to identify a patient who should have further evaluation of valvular function. The authors are from Toronto General Hospital and Sunnybrook Health Sciences Centre in Toronto.
Echocardiiographic findings for moderate or severe aortic stenosis:
(1) aortic valve area <= 1.2 square cm
(2) peak instantaneous gradient >= 25 mm Hg
Rule out rule for aortic stenosis: absence of murmur over the right clavicular head (LR 0.1).
Associated clinical findings:
(1) slow carotid artery upstroke
(2) reduced carotid artery volume
(3) maximal murmur intensity at the second right intercostal space
(4) reduced intensity of the second heart sound
Murmur over Right Clavicle
Number of Associated Clinical Findings
Interpretation
absent
NA
AS rules out (LR 0.1)
present
>= 3
moderate/severe AS (LR 40)
present
<= 2
indeterminate (LR 1.8)
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