{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:32:17Z","timestamp":1772253137710,"version":"3.50.1"},"reference-count":23,"publisher":"Sociedade Brasileira de Cardiologia","issue":"2","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Bras. Cardiol."],"abstract":"<jats:p>Resumo  Fundamento  Os exames complementares de diagn\u00f3stico substitu\u00edram a import\u00e2ncia do exame f\u00edsico (EF) na tomada de decis\u00e3o cl\u00ednica (TDC).  Objetivo  Avaliar o impacto do EF cardiovascular em cen\u00e1rios de doen\u00e7as valvulares card\u00edacas.  M\u00e9todo  Estudo intervencionista realizado com participantes volunt\u00e1rios que tiveram ou n\u00e3o a oportunidade de realizar EF em cen\u00e1rios de valvopatias. O EF foi simulado em um simulador cardiopulmonar de alta fidelidade. Os participantes receberam perguntas sobre a TDC antes e depois de receberem um laudo ECO Concordante ou ECO Discordante. O coeficiente kappa de Cohen e as tabelas de conting\u00eancia quadradas compararam a precis\u00e3o diagn\u00f3stica. Os testes ANOVA compararam o n\u00famero de exames solicitados; o n\u00edvel de signific\u00e2ncia foi estabelecido em p &lt; 0,05.  Resultados  Sessenta participantes realizaram 239 observa\u00e7\u00f5es cl\u00ednicas em 4 disfun\u00e7\u00f5es valvulares. A acur\u00e1cia diagn\u00f3stica da disfun\u00e7\u00e3o valvular foi boa (kappa = 0,935, p &lt; 0,001). Ap\u00f3s receber os laudos do ECO, a precis\u00e3o foi pior sem EF (p = 0,0047). O n\u00edvel de confian\u00e7a no diagn\u00f3stico foi 28,18% maior quando o EF foi realizado (p &lt; 0,01). Entretanto, ap\u00f3s receber os laudos do ECO, os n\u00edveis de confian\u00e7a diagn\u00f3stica foram apenas 4% maiores no grupo com EF (p = 0,03). Houve significativamente mais solicita\u00e7\u00f5es de cateterismo card\u00edaco (CATE) quando o EF n\u00e3o foi realizado (p = 0,0326). A indica\u00e7\u00e3o de interven\u00e7\u00e3o valvular n\u00e3o foi relacionada \u00e0 oportunidade ou n\u00e3o de realizar EF (79 com EF vs. 78 sem EF, p = 0,0607), mas foi influenciada pelos laudos do ECO Concordante vs. ECO Discordante (p &lt; 0,001).  Conclus\u00f5es  A realiza\u00e7\u00e3o de EF aumentou a confian\u00e7a no diagn\u00f3stico em cen\u00e1rios de valvopatia e a classifica\u00e7\u00e3o correta da disfun\u00e7\u00e3o. As decis\u00f5es de tratamento foram mais baseadas nos laudos do ECO do que no EF quando eram discordantes, e as solicita\u00e7\u00f5es de CATE aumentaram quando os participantes n\u00e3o tiveram a oportunidade de realizar EF.<\/jats:p>","DOI":"10.36660\/abc.20240272","type":"journal-article","created":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T14:05:21Z","timestamp":1742911521000},"source":"Crossref","is-referenced-by-count":0,"title":["Como o Exame F\u00edsico Cardiovascular Impacta a Tomada de Decis\u00e3o Cl\u00ednica em V\u00e1rios Cen\u00e1rios de Doen\u00e7as Valvulares Card\u00edacas"],"prefix":"10.36660","volume":"122","author":[{"given":"Isabella Silveira","family":"Teixeira","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vin\u00edcius Lima","family":"Borges","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natan","family":"Viola","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4543-4684","authenticated-orcid":false,"given":"Henrique Turin","family":"Moreira","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Pazin Filho","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1090-8165","authenticated-orcid":false,"given":"Andr\u00e9","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 Ant\u00f4nio","family":"Marin-Neto","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-3764","authenticated-orcid":false,"given":"Minna Moreira Dias","family":"Romano","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"22636","published-online":{"date-parts":[[2025]]},"reference":[{"key":"ref1","article-title":"How Valuable is Physical Examination of the Cardiovascular System?","volume":"354","author":"Elder A","year":"2016","journal-title":"BMJ"},{"key":"ref2","series-title":"The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care","author":"Topol E","year":"2011"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"195","DOI":"10.5116\/ijme.5b3f.9fb3","article-title":"The Decline of Clinical Skills: A Challenge for Medical Schools","volume":"9","author":"Faustinella F","year":"2018","journal-title":"Int J Med Educ"},{"issue":"9","key":"ref4","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1001\/jama.1997.03550090041030","article-title":"Cardiac Auscultatory Skills of Internal Medicine and Family Practice Trainees. A Comparison of Diagnostic Proficiency","volume":"278","author":"Mangione S","year":"1997","journal-title":"JAMA"},{"issue":"4","key":"ref5","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/medu.13221","article-title":"Should Learners Reason One Step at a Time? A Randomised Trial of Two Diagnostic Scheme Designs","volume":"51","author":"Blissett S","year":"2017","journal-title":"Med Educ"},{"issue":"2","key":"ref6","first-page":"167","article-title":"Simula\u00e7\u00e3o: Aspectos Conceituais","volume":"40","author":"Pazin Filho A","year":"2007","journal-title":"Medicina"},{"issue":"6","key":"ref7","article-title":"Evaluating the Effectiveness of a Structured, Simulator-Assisted, Peer-Led Training on Cardiovascular Physical Examination in Third-Year Medical Students: A Prospective, Randomized, Controlled Trial","volume":"38","author":"Kronschnabl DM","year":"2021","journal-title":"GMS J Med Educ"},{"issue":"2","key":"ref8","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ihj.2016.07.020","article-title":"Utility of Physical Examination and Comparison to Echocardiography for Cardiac Diagnosis","volume":"69","author":"Patel A","year":"2017","journal-title":"Indian Heart J"},{"issue":"2","key":"ref9","first-page":"163","article-title":"Contributions of the History, Physical Examination, and Laboratory Investigation in Making Medical Diagnoses","volume":"156","author":"Peterson MC","year":"1992","journal-title":"West J Med"},{"issue":"3","key":"ref10","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s10459-012-9388-6","article-title":"Cardiac Examination and the Effect Of Dual-Processing Instruction in a Cardiopulmonary Simulator","volume":"18","author":"Sibbald M","year":"2013","journal-title":"Adv Health Sci Educ Theory Pract"},{"issue":"4","key":"ref11","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1136\/bmjqs-2012-001537","article-title":"Do You Have to Re-Examine to Reconsider Your Diagnosis? Checklists and Cardiac Exam","volume":"22","author":"Sibbald M","year":"2013","journal-title":"BMJ Qual Saf"},{"issue":"4","key":"ref12","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/j.1365-2923.2010.03896.x","article-title":"Role of Clinical Context in Residents' Physical Examination Diagnostic Accuracy","volume":"45","author":"Sibbald M","year":"2011","journal-title":"Med Educ"},{"issue":"5969","key":"ref13","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1136\/bmj.2.5969.486","article-title":"Relative Contributions of History-Taking, Physical Examination, and Laboratory Investigation to Diagnosis and Management of Medical Outpatients","volume":"2","author":"Hampton JR","year":"1975","journal-title":"Br Med J"},{"issue":"9","key":"ref14","doi-asserted-by":"crossref","first-page":"751","DOI":"10.7326\/0003-4819-117-9-751","article-title":"Assessing Housestaff Diagnostic Skills Using a Cardiology Patient Simulator","volume":"117","author":"St Clair EW","year":"1992","journal-title":"Ann Intern Med"},{"issue":"140","key":"ref15","article-title":"A Technique for the Measurement of Attitudes","volume":"22","author":"Likert R","year":"1932","journal-title":"Arch Psychol"},{"issue":"2","key":"ref16","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1046\/j.1525-1497.1999.00298.x","article-title":"Impact of a Clinical Scenario on Accuracy of Electrocardiogram Interpretation","volume":"14","author":"Hatala R","year":"1999","journal-title":"J Gen Intern Med"},{"issue":"3","key":"ref17","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-068121","article-title":"Diagnostic Accuracy of Heart Auscultation for Detecting Valve Disease: A Systematic Review","volume":"13","author":"Davidsen AH","year":"2023","journal-title":"BMJ Open"},{"issue":"7","key":"ref18","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the Management of Valvular Heart Disease","volume":"43","author":"Vahanian A","year":"2022","journal-title":"Eur Heart J"},{"issue":"8","key":"ref19","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1016\/j.echo.2023.05.001","article-title":"A Vision for the Future of Quality in Echocardiographic Reporting: The American Society of Echocardiography ImageGuideEcho Registry, Current and Future States","volume":"36","author":"Nagueh SF","year":"2023","journal-title":"J Am Soc Echocardiogr"},{"issue":"40","key":"ref20","doi-asserted-by":"crossref","first-page":"4101","DOI":"10.1093\/eurheartj\/ehab327","article-title":"Cardiovascular Clinical Examination: The Need for an Evidence-Based Approach","volume":"42","author":"Karthikeyan G","year":"2021","journal-title":"Eur Heart J"},{"issue":"8","key":"ref21","doi-asserted-by":"crossref","first-page":"2188","DOI":"10.12669\/pjms.38.8.5392","article-title":"Diagnostic Errors: Association with Level of Expertise, Effect of Time Taken to Reach the Diagnosis and Utilization of Differential Diagnosis Checklists among Postgraduate Trainees","volume":"38","author":"Khan H","year":"2022","journal-title":"Pak J Med Sci"},{"issue":"13","key":"ref22","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1001\/archinte.165.13.1493","article-title":"Diagnostic Error in Internal Medicine","volume":"165","author":"Graber ML","year":"2005","journal-title":"Arch Intern Med"},{"issue":"21","key":"ref23","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1093\/eurheartj\/ehad121","article-title":"Unmet Needs in Valvular Heart Disease","volume":"44","author":"Messika-Zeitoun D","year":"2023","journal-title":"Eur Heart J"}],"container-title":["Arquivos Brasileiros de Cardiologia"],"original-title":["How Cardiovascular Physical Examination Impacts Clinical Decision-Making in Various Scenarios of Cardiac Valvular Diseases"],"link":[{"URL":"https:\/\/abccardiol.org\/wp-content\/uploads\/articles_xml\/0066-782X-abc-122-2-e20240272\/0066-782X-abc-122-2-e20240272.x80891.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,25]],"date-time":"2025-03-25T14:06:12Z","timestamp":1742911572000},"score":1,"resource":{"primary":{"URL":"https:\/\/abccardiol.org\/article\/como-o-exame-fisico-cardiovascular-impacta-a-tomada-de-decisao-clinica-em-varios-cenarios-de-doencas-valvulares-cardiacas\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":23,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025]]}},"alternative-id":["S0066-782X2025000200307"],"URL":"https:\/\/doi.org\/10.36660\/abc.20240272","relation":{"is-translation-of":[{"id-type":"doi","id":"10.36660\/abc.20240272i","asserted-by":"subject"},{"id-type":"doi","id":"10.36660\/abc.20240272i","asserted-by":"object"}]},"ISSN":["1678-4170","0066-782X"],"issn-type":[{"value":"1678-4170","type":"electronic"},{"value":"0066-782X","type":"print"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e20240272"}}