Can Heart Murmurs Reliably Detect Valvular Disease?
Heart auscultation by primary care providers detected heart murmurs in nearly 1 in 4 individuals in a Norwegian population. While murmurs were particularly useful for detecting aortic stenosis, their sensitivity for other significant valvular heart diseases was limited — underscoring the need for echocardiography in older or high-risk individuals.
METHODOLOGY:
Researchers assessed the prevalence of heart murmurs among residents of a Norwegian municipality who participated in a 2015-2016 study to determine if murmurs accurately diagnose valvular heart disease.
The study included 2082 adults aged 40 years or older (mean age, 64 years; 54% women) and recorded heart sounds at four auscultation sites on the chest using a modified analog stethoscope.
A panel of primary care providers and a cardiologist used a structured consensus process to classify each recording as normal, a systolic murmur, a diastolic murmur, or noise.
Participants underwent echocardiography on the same day as the heart sound recording to identify the presence of valvular heart disease, including stenosis and regurgitation.
Diagnostic performance was evaluated by calculating sensitivity, specificity, and predictive parameters, using echocardiography as the reference standard.
TAKEAWAY:
Among 487 participants (23%) with heart murmurs, 484 had systolic murmurs and nine had diastolic murmurs; murmurs were more frequent in women, participants aged 70 years or older, and those with hypertension, diabetes, or a history of certain heart conditions.
Only 35.5% of participants with significant valvular disease had an audible murmur; however, all participants with aortic stenosis had an audible murmur.
Systolic murmurs had a low sensitivity for most valvular diseases — apart from aortic stenosis — yet distinct systolic murmurs had greater than 94% specificity. Diastolic murmurs were uncommon and identified any valvular heart disease with greater than 99% specificity but very low sensitivity.
Among participants with murmurs, factors independently associated with valvular disease included male sex (adjusted odds ratio [aOR], 3.3; 95% CI, 2.0-5.3), a prior heart attack (aOR, 2.3; 95% CI, 1.04-5.2), and older age (≥ 70 years; aOR, 2.0; 95% CI, 1.2-3.4).
IN PRACTICE:
Because valvular heart disease is more likely with age, 'finding the right cut-off for referring the elderly to further examinations might be important in the future with an increasing population of elderly people,' the researchers reported.
'A possible intermediate step before a more widespread implementation of ultrasound could be the use of electronic stethoscopes and computer programs or applications helping the physician to interpret the heart sounds of the patient,' they added.
SOURCE:
This study was led by Anne Herefoss Davidsen, of UiT The Arctic University of Norway in Tromsø, Norway. It was published online on August 1, 2025, in Heart.
LIMITATIONS:
Only two physicians performed most of the heart-sound ratings. Heart sounds were classified on the basis of recordings rather than real-life auscultation. Participation bias may have remained as individuals who are healthier tend to participate more than those who stay at home, especially among older age groups.
DISCLOSURES:
This study received funding from The Norwegian Medical Association General Practice Research Fund. Four authors reported being involved in a patent application related to an algorithm designed to detect heart disease from heart sound recordings. One author reported receiving grants, consulting fees, and lecture fees from several pharmaceutical companies including Novartis, AstraZeneca, and Pfizer. The same author reported holding an unpaid leadership/board member position with the Norwegian Council on Cardiovascular Diseases and the Norwegian Council on Dementia.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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