Usefulness of the second heart sound for predicting pulmonary hypertension in patients with interstitial lung disease.

Autor:	Cobra Sde B; Hospital de Base do Distrito Federal, Brasília, Federal District, Brazil., Cardoso RM; Universidade de Brasília, Brasília, Federal District, Brazil., Rodrigues MP; School of Medicine, Universidade de Brasília, Brasília, Federal District, Brazil.
Jazyk:	angličtina
Zdroj:	Sao Paulo medical journal = Revista paulista de medicina [Sao Paulo Med J] 2016 Jan-Feb; Vol. 134 (1), pp. 34-9. Date of Electronic Publication: 2016 Jan 19.
DOI:	10.1590/1516-3180.2015.00701207
Abstrakt:	Context and Objective: P2 hyperphonesis is considered to be a valuable finding in semiological diagnoses of pulmonary hypertension (PH). The aim here was to evaluate the accuracy of the pulmonary component of second heart sounds for predicting PH in patients with interstitial lung disease. Design and Setting: Cross-sectional study at the University of Brasilia and Hospital de Base do Distrito Federal. Methods: Heart sounds were acquired using an electronic stethoscope and were analyzed using phonocardiography. Clinical signs suggestive of PH, such as second heart sound (S2) in pulmonary area louder than in aortic area; P2 > A2 in pulmonary area and P2 present in mitral area, were compared with Doppler echocardiographic parameters suggestive of PH. Sensitivity (S), specificity (Sp) and positive (LR+) and negative (LR-) likelihood ratios were evaluated. Results: There was no significant correlation between S2 or P2 amplitude and PASP (pulmonary artery systolic pressure) (P = 0.185 and 0.115; P= 0.13 and 0.34, respectively). Higher S2 in pulmonary area than in aortic area, compared with all the criteria suggestive of PH, showed S = 60%, Sp= 22%; LR+ = 0.7; LR- = 1.7; while P2> A2 showed S= 57%, Sp = 39%; LR+ = 0.9; LR- = 1.1; and P2 in mitral area showed: S= 68%, Sp = 41%; LR+ = 1.1; LR- = 0.7. All these signals together showed: S= 50%, Sp = 56%. Conclusions: The semiological signs indicative of PH presented low sensitivity and specificity levels for clinically diagnosing this comorbidity.
Databáze:	MEDLINE
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