Cardiac auscultation versus two-dimensional transthoracic echocardiography for detection of valve disease in Erbil City

Aims: Auscultation is a straight forward and inexpensive method for the preliminary diagnosis of heart valve disease. However, many valve diseases are clinically silent and therefore echocardiography may be the preferred option. In this prospective study we aimed to investigate the sensitivity of auscultation in patients with mitral and aortic valve disease in comparison to Doppler echocardiography. Methods: 300 consecutive patients with heart valve disease who attended the echocardiography department at Erbil Cardiac Centre between May 2015 and February 2016 were included in this study. Patients were excluded if they were under 15 years of age, had poor window echocardiography, had prosthetic aortic and/or mitral valves, had a history of infective endocarditis, were pregnant or had congenital heart diseases. All of the included patients underwent cardiac auscultation of the mitral and aortic valve, which was carried out by 2 experienced cardiologists. All of these patients were then investigated by transthoracic echocardiography. Results: 215 mitral valve lesions and 122 aortic valve lesions were detected by echocardiography. The most common lesion detected was mitral regurgitation followed by aortic regurgitation, aortic stenosis and mitral stenosis. Auscultation was only able to detect 51.6% of the mitral valve lesions and 56.6% of the aortic valve lesions. There was a significant association between inaudible murmurs and mild valve lesions on echocardiography (p = 0.001) and between inaudible murmurs and systolic dysfunction as identified by echocardiography (p = 0.001). Conclusions: Approximately half of the valve diseases detected by echocardiography were silent clinically.