Correlation of intensity of aortic stenosis murmur by auscultation with echocardiographically determined transvalvular gradients and valve area

The importance of auscultatory findings in aortic stenosis is well recognized. However, there is no prospective data correlating the grade of systolic murmur (the most common and constant sign) with echocardiographically determined valvular pressure gradients and valve area in aortic stenosis. This study included 54 consecutive patients with aortic stenosis. Patients with atrial fibrillation, congestive heart failure, left ventricular ejection fraction 2, decreased intensity of S₂, sustained apical impulse, carotid delay, radiation of murmur to neck, and quality of murmur - were also evaluated. Echocardiographic studies were carried out using standard protocols. The predictive value for correctly identifying the degree of severity of murmur intensity based on echocardiographically derived peak gradient was 87%; the mean gradient, 81%; and the valve area, 87%. The grade of murmur was the most significant variable followed by carotid delay, mid/late systolic peak, and decreased A(s)/S₂ intensity. These data suggest that the auscultative grade of aortic systolic murmurs is statistically associated with echocardiographically derived mean and peak gradients and valve area in aortic stenosis. The grade of the murmur was most accurate in differentiating mild from moderate/severe aortic stenosis. Auscultation is the most useful screening procedure for selecting patients for further evaluation and follow up and may lead to significant improvement in utilization of costly procedures.