Diagnostic accuracy of heart murmur in newborns with suspected congenital heart disease

BACKGROUND: The correlation between heart murmur and congenital heart disease (CHD) is complex and varies with observed population. METHODS: Ninety consecutive newborns (41 with heart murmur and 49 controls) were routinely examined with auscultation and echocardiography. Intensity and characteristics of heart murmur, presence and type of CHD were recorded. Echocardiographic findings were considered as benchmark. RESULTS: Heart murmur was related to the presence of ostium secundum [odds ratio (OR) 4.2], patent ductus arteriosus (OR 11.9), tricuspidal regurgitation (OR 9.5), muscle ventricular septal defect (VSD) (OR 12.3), membranous VSD (OR 9.7), and any CHD (OR 26.7) (P < 0.05 in all cases). Diagnostic accuracy of clinical examination with a finding of heart murmur was 83%, lower if considering single CHD (58-69%), negative predictive value 90%, and positive predictive value 76%. Patients with any CHD, tricuspidal regurgitation and muscle VSD were characterized by a more intense heart murmur. In case of concomitant multiple CHD, intensity of heart murmur correlated with the number of congenital heart anomalies. CONCLUSION: Diagnostic accuracy of heart murmur at clinical examination (83%) declines when single CHDs are considered. Higher negative predictive value and lower positive predictive value suggest an echocardiographic second-level confirmation in the case of heart murmur at clinical examination suspected for CHD, probably unnecessary in the case of negative auscultative findings. Heart murmur intensity correlates with the number of concomitant congenital heart anomalies.