Source: International Congress 2016 – Pulmonary hypertension and pulmonary embolism: from the bench to the bedside
Disease area: Pulmonary vascular diseases

Abstract

Background and ObjectiveLittle is known about the utility of physical examination (PE) findings in patients with suspected pulmonary hypertension (PH) in the modern era. We aimed to determine the diagnostic utility of commonly referenced PE findings for PH when compared to the gold standard, right heart catheterization (RHC)MethodsSequential patients undergoing RHC at the PH clinic in Calgary, Canada were prospectively enrolled and examined by a respirologist within 60 minutes of RHC. Examiners were blinded to indication and diagnosis. Examiners determined presence or absence of: high jugular venous pressure (JVP)>3cm, palpable P2, parasternal heave, abdominal-jugular reflex (AJR), loud P2, P2 louder than A2 (P2>A2), right-sided S3, and extra-physiologic splitting of S2. PE findings were compared to RHC to determine the sensitivity (Sn), specificity (Sp), positive (+LR) and negative likelihood ratio (-LR) values for identifying PH (mPAP³25mmHg).Results105 patients were enrolled. 66% were female with a median age of 61 (Interquartile Range 28-85). 13 patients (12%) did not have PH (mPAP <25 mmHg). The diagnostic performances of PE findings are displayed in Table 1.

Table 1

Examination Finding	Sn	Sp	+LR (95%CI)	-LR(95%CI)
JVP>3cm	70	67	2.1 (0.9-4.7)	0.45 (0.27-0.76)
Palpable P2	31	62	0.82 (0.38-1.7)	1.1 (0.7-1.7)
Parasternal heave	40	79	1.8 (0.63-4.9)	0.77 (0.55-1.1)
AJR	55	69	1.8 (0.77-4.1)	0.66 (0.42-1.0)
Loud P2	81	31	1.2 (0.8-1.7)	0.6 (0.24-1.5)
P2>A2	66	54	1.4 (0.8-2.6)	0.6 (0.24-1.5)
Right-sided S3	15	92	2.0 (0.3-13.8)	0.91 (0.8-1.1)
Extra-physiologic Split S2	21	92	2.7 (0.4-18.6)	0.86 (0.7-1.0)

 

ConclusionsThe physical examination has inadequate diagnostic utility in detecting or excluding the presence of PH.


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Kevin Solverson (Calgary, Canada), Kevin Solverson, Daniel Vis, Micheal Braganza, Jeff Shaw, Luke Rannelli, Mitesh Thakrar, Rhea Varughese, Naushad Hirani, Doug Helmersen, Jason Weatherald. Diagnostic utility of the physical examination for pulmonary hypertension. Eur Respir J 2016; 48: Suppl. 60, 2480

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