Comprehensive evaluation of the apex beat using 64-slice computed tomography: Impact of left ventricular mass and distance to chest wall

Shoichi Ehara, Takuhiro Okuyama, Nobuyuki Shirai, Hiroki Oe, Yoshiki Matsumura, Kenichi Sugioka, Toshihide Itoh, Katharina Otani, Takeshi Hozumi, Minoru Yoshiyama, Junichi Yoshikawa

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Although physicians frequently perform palpation of the apex beat to evaluate left ventricular (LV) size and hypertrophy, the clinical significance of apex beat palpation is still unclear. The introduction of multislice computed tomography (MSCT) has enabled assessment not only of coronary stenoses but also LV volume, mass, and distance from heart to chest wall. The aim of this study was to evaluate the relationships among presence, location, and sustained or double apical impulse of apex beat and LV function, volume, mass, and distance from heart to chest wall determined by MSCT. Methods and results: The study population consisted of 200 consecutive patients clinically indicated for MSCT angiography for coronary artery evaluation. Apex palpation was performed with the patients in the supine and left lateral decubitus positions. Multivariate analysis revealed that LV mass index (p <0.01), distance (p <0.005), and being male (p <0.005) remained independent factors associated with presence of apex beat in the supine position, and that LV mass index was also associated with location of apex beat. Furthermore, in patients with a palpable apex beat, LV mass index was an independent factor associated with patterns of sustained or double apical impulse. In the group of all patients, patterns of sustained or double apical impulse in the supine position had a sensitivity of 57%, specificity of 90%, positive predictive value of 68%, and negative predictive value of 85% as an indicator of LV hypertrophy. Conclusion: Palpation of the apex beat is a sensitive diagnostic maneuver for excluding patients with increased LV mass. We believe that our observations have important implications for bedside clinical examination.

Original languageEnglish
Pages (from-to)256-265
Number of pages10
JournalJournal of Cardiology
Volume55
Issue number2
DOIs
Publication statusPublished - Mar 2010
Externally publishedYes

Fingerprint

Thoracic Wall
Palpation
Tomography
Multidetector Computed Tomography
Supine Position
Left Ventricular Hypertrophy
Coronary Stenosis
Left Ventricular Function
Coronary Vessels
Multivariate Analysis
Physicians
Sensitivity and Specificity
Population

Keywords

  • Apex beat
  • Apical impulse
  • Computed tomography
  • Hypertrophy
  • Palpation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comprehensive evaluation of the apex beat using 64-slice computed tomography : Impact of left ventricular mass and distance to chest wall. / Ehara, Shoichi; Okuyama, Takuhiro; Shirai, Nobuyuki; Oe, Hiroki; Matsumura, Yoshiki; Sugioka, Kenichi; Itoh, Toshihide; Otani, Katharina; Hozumi, Takeshi; Yoshiyama, Minoru; Yoshikawa, Junichi.

In: Journal of Cardiology, Vol. 55, No. 2, 03.2010, p. 256-265.

Research output: Contribution to journalArticle

Ehara, S, Okuyama, T, Shirai, N, Oe, H, Matsumura, Y, Sugioka, K, Itoh, T, Otani, K, Hozumi, T, Yoshiyama, M & Yoshikawa, J 2010, 'Comprehensive evaluation of the apex beat using 64-slice computed tomography: Impact of left ventricular mass and distance to chest wall', Journal of Cardiology, vol. 55, no. 2, pp. 256-265. https://doi.org/10.1016/j.jjcc.2009.11.008
Ehara, Shoichi ; Okuyama, Takuhiro ; Shirai, Nobuyuki ; Oe, Hiroki ; Matsumura, Yoshiki ; Sugioka, Kenichi ; Itoh, Toshihide ; Otani, Katharina ; Hozumi, Takeshi ; Yoshiyama, Minoru ; Yoshikawa, Junichi. / Comprehensive evaluation of the apex beat using 64-slice computed tomography : Impact of left ventricular mass and distance to chest wall. In: Journal of Cardiology. 2010 ; Vol. 55, No. 2. pp. 256-265.
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abstract = "Objectives: Although physicians frequently perform palpation of the apex beat to evaluate left ventricular (LV) size and hypertrophy, the clinical significance of apex beat palpation is still unclear. The introduction of multislice computed tomography (MSCT) has enabled assessment not only of coronary stenoses but also LV volume, mass, and distance from heart to chest wall. The aim of this study was to evaluate the relationships among presence, location, and sustained or double apical impulse of apex beat and LV function, volume, mass, and distance from heart to chest wall determined by MSCT. Methods and results: The study population consisted of 200 consecutive patients clinically indicated for MSCT angiography for coronary artery evaluation. Apex palpation was performed with the patients in the supine and left lateral decubitus positions. Multivariate analysis revealed that LV mass index (p <0.01), distance (p <0.005), and being male (p <0.005) remained independent factors associated with presence of apex beat in the supine position, and that LV mass index was also associated with location of apex beat. Furthermore, in patients with a palpable apex beat, LV mass index was an independent factor associated with patterns of sustained or double apical impulse. In the group of all patients, patterns of sustained or double apical impulse in the supine position had a sensitivity of 57{\%}, specificity of 90{\%}, positive predictive value of 68{\%}, and negative predictive value of 85{\%} as an indicator of LV hypertrophy. Conclusion: Palpation of the apex beat is a sensitive diagnostic maneuver for excluding patients with increased LV mass. We believe that our observations have important implications for bedside clinical examination.",
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AU - Matsumura, Yoshiki

AU - Sugioka, Kenichi

AU - Itoh, Toshihide

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AU - Hozumi, Takeshi

AU - Yoshiyama, Minoru

AU - Yoshikawa, Junichi

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