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Aortic Regurgitation: Sensitivity and Specificity

Introduction: None written.

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Tags: Cardiac Problem Valvular Lesion Tag this Diagnosis.

The sensitivity and specificity of findings for Aortic Regurgitation are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)


Finding	Result	Sensitivity	Specificity
[ + ] Austin Flint Murmur		Sensitivity = 25%
"The murmur typically begins in mid-diastole, often has a presystolic accentuation, and terminates at the end of diastole. It is low-pitched, with a rough and rumbling quality, and best heard at the apex. An Austin Flint murmur can be deemed present only in the setting of aortic regurgitation without coexisting mitral stenosis, since the latter can generate a similar murmur." Sensitivity reported 25-100% in various studies. This source says that "specificity is irrelevant since Austin Flint murmur is by definition only found in AR". Study: http://www.annals.org/cgi/reprint/138/9/736.pdf
[ + ] de Musset's Sign		No accuracy specified.
head bobbing with systolic pulse. Poor sensitivity and specificity. Study: South Med J. 1981 Apr;74(4):459-67. 7013091
[ + ] Duroziez's Femoral Murmur	+ 0 -	88%	100%
press down on the femoral artery with the stethoscope - at one point you should hear 2 murmurs. Study: South Med J. 1981 Apr;74(4):459-67. 7013091
[ + ] Early Diastolic Murmur	+ 0 -	76%	96%
Study: JAMA. 1999;281:2231-2238. http://jama.ama-assn.org/cgi/content/full/281/23/2231
[ + ] Hill's Sign		Sensitivity = 69%
difference in systolic BP between popliteal and brachial arteries > 20mmHg (popliteal > brachial). Correlates with degree of AR. Study: South Med J. 1981 Apr;74(4):459-67. 7013091
[ + ] Quincke's Pulse		No accuracy specified.
Poor sensitivity and specificity - this finding merely reflects wide pulse pressure. From what I gather, it involves pushing on the nail bed to blanch it, but then being able to see pulsations (i.e. your pressure is between systolic and diastolic). Study: South Med J. 1981 Apr;74(4):459-67. 7013091