What question did this study set out to answer?

Evaluate the diagnostic accuracy of physical examination findings in determining the severity of aortic stenosis.

April 1, 2026

Absence of second heart sound in assessing aortic stenosis severity

Q: What does this research mean for the field?

The absence of the second heart sound during physical examination accurately identifies severe aortic stenosis with a diagnostic accuracy of 0.76, 63% sensitivity, and 89% specificity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Resultado clave

Absence of the second heart sound accurately identifies severe aortic stenosis with a diagnostic accuracy of 0.76, 63% sensitivity, and 89% specificity.

Puntos clave

Evaluate the diagnostic accuracy of physical examination findings in determining the severity of aortic stenosis.
Enrolled consecutive patients with aortic stenosis over two years.
Classified patients as severe or non-severe based on echocardiographic findings.
Conducted a cardiac physical examination by a blinded cardiologist.
Assessed inter-observer reliability with a second blinded cardiologist.
220 patients included with 111 diagnosed with severe aortic stenosis.
Absence of second heart sound showed highest diagnostic accuracy of 0.76.
Sensitivity of absence of S2 was 63% and specificity was 89%.
Positive predictive value was 0.85, negative predictive value was 0.71.
Inter-observer reliability for absence of S2 was substantial with a Cohen Kappa of 0.66.

PICO estructurado

Does the absence of the second heart sound (S2) on physical examination accurately identify severe aortic stenosis?

Población

220 patients with aortic stenosis (111 severe [AVA <1cm²], 109 non-severe [AVA >1cm²]), mean age 78±8 years, 43% women.

Intervención

Physical examination assessing the absence of the second heart sound (S2)

Comparador

Echocardiography reference standard (severe AS defined as aortic valve area <1cm²)

Resultado

Diagnostic accuracy of physical examination findings (absence of S2) in assessing the severity of aortic stenosis

The absence of the second heart sound on physical examination is a highly specific (89%) clinical sign for identifying severe aortic stenosis, with substantial inter-observer reliability.

Resultado numérico

Tasa de eventos absoluta: 0% vs 0%

Resumen

Abstract Background Physical examination remains the essential initial tool for the diagnosis of aortic stenosis (AS). Objectives This study aimed to evaluate the accuracy of various physical examination findings in assessing the severity of AS. Methods We prospectively enrolled consecutive patients with AS over about a two-year period. Patients were classified as having severe (aortic valve area AVA 1cm²) or non-severe (AVA 1cm²) AS based on echocardiographic findings. A cardiologist, blinded to these findings, performed a cardiac physical examination. Subsequently, a second cardiologist, also blinded to prior data, examined the patients to assess inter-observer reliability. Results A total of 220 patients (mean age 78±8 years, 43% women) were included, with 111 (50,5%) diagnosed with severe AS and 109 (49,5%) with non-severe AS (82 moderate and 27 mild AS). Among the physical examination findings, the absence of the second heart sound (S2) demonstrated the highest diagnostic accuracy (0.76; 95% CI, 0.70–0.81; p 0.001), with a sensitivity of 63%, specificity of 89%, positive predictive value (PPV) of 0.85, and negative predictive value (NPV) of 0.71. The inter-observer reliability for the absence of S2 was substantial (Cohen Kappa 0.66). Conclusions The absence of S2 offers good diagnostic accuracy for distinguishing between moderate and severe AS, highlighting its utility in clinical practice.Figure 1For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.

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