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      Physical Examination and ECG Screening in Relation to Echocardiography Findings in Young Healthy Adults

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          Background and Aims: Cardiovascular screening in young adults is an important tool in many occupational settings. Our aim was to test whether screening physical examination and ECG influence the rate of abnormal echocardiogarphic findings in young healthy subjects. Methods: Consecutive echocardiography results of 18- to 20-year-old flight candidates were analyzed retrospectively. Echocardiographies were performed as part of a screening protocol, which includes ECG, physical examination and referral for echocardiography for any positive finding. A second stage includes universal echocardiography for all candidates. Results: 1,066 subjects were evaluated; 489 subjects underwent echocardiography following referral because of abnormal auscultatory or ECG findings. Findings (mostly mild valvular insufficiencies) were demonstrated in 12.7%, with only 0.6% of subjects disqualified. In subjects who underwent universal echocardiography (n = 577), findings (mostly mild valvular insufficiencies) were detected in 18%, with only 0.5% of subjects disqualified. Conclusions: The rate of significant echocardiography findings is extremely low in this young and healthy population. The presence of abnormal findings on either physical examination or ECG screening was not demonstrated to alter the rate of abnormal echocardiographic findings. We suggest that the low yield of screening should be weighed against the cost of an unidentified congenital cardiac lesion in the specific setting.

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          Most cited references 11

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          Prevalence and clinical outcome of mitral-valve prolapse.

          Mitral-valve prolapse has been described as a common disease with frequent complications. To determine the prevalence of mitral-valve prolapse in the general population, as diagnosed with the use of current two-dimensional echocardiographic criteria, we examined the echocardiograms of 1845 women and 1646 men (mean [+/-SD] age, 54.7+/-10.0 years) who participated in the fifth examination of the offspring cohort of the Framingham Heart Study. Classic mitral-valve prolapse was defined as superior displacement of the mitral leaflets of more than 2 mm during systole and as a maximal leaflet thickness of at least 5 mm during diastasis, and nonclassic prolapse was defined as displacement of more than 2 mm, with a maximal thickness of less than 5 mm. A total of 84 subjects (2.4 percent) had mitral-valve prolapse: 47 (1.3 percent) had classic prolapse, and 37 (1.1 percent) had nonclassic prolapse. Their age and sex distributions were similar to those of the subjects without prolapse. None of the subjects with prolapse had a history of heart failure, one (1.2 percent) had atrial fibrillation, one (1.2 percent) had cerebrovascular disease, and three (3.6 percent) had syncope, as compared with unadjusted prevalences of these findings in the subjects without prolapse of 0.7, 1.7, 1.5, and 3.0 percent, respectively. The frequencies of chest pain, dyspnea, and electrocardiographic abnormalities were similar among subjects with prolapse and those without prolapse. The subjects with prolapse were leaner (P<0.001) and had a greater degree of mitral regurgitation than those without prolapse, but on average the regurgitation was classified as trace or mild. In a community based sample of the population, the prevalence of mitral-valve prolapse was lower than previously reported. The prevalence of adverse sequelae commonly associated with mitral-valve prolapse in studies of patients referred for that diagnosis was also low.
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            The prevalence of bicuspid aortic valve in newborns by echocardiographic screening.

            This study was carried out to determine the true prevalence of bicuspid aortic valve (BAV) in newborns, which has not yet been determined. One thousand seventy five live born neonates (567 male neonates, 508 female neonates; gestational ages ranging from 27 to 42 weeks, and birth weights ranging from 720 to 4,780 g) were screened by transthoracic 2-dimensional echocardiography to assess the prevalence of BAV. BAV was identified in a prevalence of 4.6 in 1,000 live births. The prevalence of BAV by sex was 7.1 of 1,000 in male neonates, and 1.9 of 1,000 in female neonates. All newborns with BAV were asymptomatic. Mild aortic regurgitation was found in only 1 neonate with BAV. Because BAV may result in aortic valvular stenosis and/or regurgitation, a recommendation of regular follow-ups and antibiotic prophylaxis for infective endocarditis should be necessary.
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              Frequency of bicuspid aortic valve in young male conscripts by echocardiogram.

              The database of echocardiographic examinations performed during the military screening of 20,946 young men in northeastern Italy was systematically reviewed to assess the frequency, hemodynamic characteristics, and aortic sizes of subjects with bicuspid aortic valves (BAVs). One hundred sixty-seven patients with BAVs were identified (0.8%), of whom 80 (48%) were diagnosed de novo during military screening. Aortic insufficiency was the predominant hemodynamic lesion in 110 subjects (66%), mild in 90, and moderate to severe in 20. Patients with BAVs displayed larger aortic sizes than controls at each aortic level, and the degree of dilation was related to the presence but not the severity of aortic insufficiency.

                Author and article information

                S. Karger AG
                February 2008
                27 August 2007
                : 109
                : 3
                : 202-207
                aAeromedical Center, Israeli Air Force, and bDepartment of Internal Medicine B, Sheba Medical Center, Tel Hashomer, cHeart Institute, Wolfson Medical Center, Holon, and dSackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
                106684 Cardiology 2008;109:202–207
                © 2007 S. Karger AG, Basel

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                Figures: 1, Tables: 3, References: 33, Pages: 6
                Original Research


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