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Tierarztl Prax Ausg K Kleintiere Heimtiere 2012; 40(02): 103-111
DOI: 10.1055/s-0038-1623629
Original Article
Schattauer GmbH

Comparison of conventional and sensor-based electronic stethoscopes in detecting cardiac murmurs of dogs

Vergleichende Untersuchung zur Detektion von Herzgeräuschen beim Hund mit konventionellen und elektronischen Stethoskopen
K. Vörös
1   Department and Clinic of Internal Medicine, Faculty of Veterinary Science, Szent István University, Budapest, Hungary
,
L. A. Bonnevie
1   Department and Clinic of Internal Medicine, Faculty of Veterinary Science, Szent István University, Budapest, Hungary
,
M. J. Reiczigel
2   Department of Biomathematics and Informatics, Faculty of Veterinary Science, Szent István University, Budapest, Hungary
› Author Affiliations
Further Information

Publication History

Eingegangen: 24 November 2010

Akzeptiert nach Revision: 16 June 2011

Publication Date:
06 January 2018 (online)

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Summary

Background and objective: Cardiac auscultation is one of the most important parts of the cardiological examination traditionally performed with acoustic stethoscopes.The aim of this study was to compare the sensitivities and the diagnostic capabilities of traditional and electronic stethoscopes in detecting canine heart murmurs. Materials and methods: The study was performed on 21 dogs referred for cardiologic examination with suspected heart murmurs. Six out of these dogs had cardiac murmurs bilaterally. Cardiac auscultation was performed independently by a final-year veterinary student (AB = I1) and by an experienced clinician (KV = I2), both using a traditional and a Welch Allyn Meditron electronic sensor-based stethoscope. Final diagnoses were established by echocardiography and by digital phonocardiography. Results: Correct detection of a murmur was made by I1 with a traditional stethoscope in 20/27 (74.0%) of the suspected murmurs (p = 0.30, kappa [κ] = 0.2) and with the electronic stethoscope in 26/27 (96.3%), respectively (p = 0.0013, κ = 0.75). I2 correctly detected the murmurs with the traditional stethoscope in 25/27 (92.6%) cases (p = 0.0013, κ = 0.75) and with the electronic stethoscope in all 27/27 (100%) cases (p = 0.00012, κ = 1). Agreements of murmur intensity gradings between traditional and electronic stethoscopes were highly significant (I1: p = 6.9 × 10−8; κ = 0.79), (I2: p = 5.2 × 10−11; κ = 0.92). When grading the murmurs with the traditional stethoscope, there was a significant agreement between I1 and I2 (p = 2.9 × 10−7; κ = 0.79), being even higher with the electronic stethoscope (p = 1.1 × 10−11; κ = 0.92). Conclusion: The electronic stethoscope was more sensitive than the traditional one in detecting and grading cardiac murmurs being especially useful for I1 with less experience. However, it can be suggested to use a traditional and an electronic stethoscopes simultaneously to optimally utilize their advantages.

Zusammenfassung

Gegenstand und Ziel: Die Herzauskultation, ein wichtiger Bestandteil der kardiologischen Untersuchung, erfolgt traditionell mit konventionellen, akustischen Stethoskopen. Ziel der Studie war, Sensitivität und diagnostische Kapazität eines traditionellen und eines elektronischen Stethoskops (TS bzw. ES) zum Nachweis von Herzgeräuschen (HG) beim Hund zu vergleichen. Material und Methoden: Die Auskultation erfolgte bei 21 überwiesenen Hunden mit Verdacht auf ein HG. Bei sechs Hunden lag das HG beidseitig vor. Zwei Untersucher (U1: AB, Veterinärmedizinstudentin im letzten Studienjahr; U2: KV, Kliniker mit großer Erfahrung in der Herzauskultation) führten die Auskultation unabhängig voneinander mit einem TS und einem elektronischen, “sensor-based” Stethoskop (Welch Allyn Meditron) durch. Die definitiven kardiologischen Diagnosen im Vergleich zu den Merkmalen der HG (Anwesenheit, Lautstärke, klinische Relevanz) wurden sonographisch mittels M-Mode, zweidimensionaler und Dopplerechokardiographie bzw. durch Analyse der digitalen Phonokardiogramme gestellt. Ergebnisse: Ein korrekter Nachweis des HG gelang U1 mit dem TS in 20/27 (74,0%, p = 0,30, kappa [κ] = 0,2) und mit dem ES in 26/27 (96,3%) Fällen (p = 0,0013, κ = 0,75). U2 erkannte die HG mit dem TS in 25/27 (92,6%, p = 0,0013, κ = 0,75), mit dem ES in allen 27/27 (100%) Fällen richtig (p = 0,00012, κ = 1). Hinsichtlich der mit dem TS bzw. ES ermittelten Lautstärke der HG (1/6 bis 6/6) bestand für U1 (p = 6,9 × 10−8; κ = 0,79) wie für U2 (p = 5,2 × 10−11; κ = 0,92) eine hochsignifikante Übereinstimmung. Bei der Einstufung der HG nach der Lautstärke mit dem TS wurde eine signifikante Übereinstimmung zwischen den Resultaten von U1 und U2 festgestellt (p = 2,9 × 10−7; κ = 0,79). Mit dem ES ergab sich eine noch höhere Übereinstimmung zwischen den Ergebnissen beider Untersucher (p = 1,1 × 10−11; κ = 0,92). Schlussfolgerung: Das ES zeigte sich sensitiver bei der HG-Erkennung und der Einstufung der Lautstärke als das TS. Besonders nützlich war es für U1 mit weniger Erfahrung bei der Herzauskultation. Um von den Vorteilen beider Instrumente optimal zu profitieren, empfiehlt sich deren simultane Verwendung.

Key words

Auscultation - canine - electronic - stethoscope - heart - cardiac murmur

Schlüsselwörter

Auskultation - Hund - elektronisch - Phonendoskop - Herz - Herzgeräusch
 

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