A Prospective Evaluation of the Diagnostic Accuracy of the Physical Examination for Pulmonary Hypertension
| Autor: | Michael Braganza, Rhea Varughese, Jeffrey Shaw, Mitesh V. Thakrar, Jason Weatherald, Doug Helmersen, Daniel Vis, Kevin Solverson, Juri Janovcik, Naushad Hirani |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Cardiac Catheterization Fourth heart sound Peripheral edema Physical examination Critical Care and Intensive Care Medicine Risk Assessment Sensitivity and Specificity Severity of Illness Index Alberta Cohort Studies Tertiary Care Centers Predictive Value of Tests Internal medicine Task Performance and Analysis Medicine Humans Prospective Studies Pulmonary Wedge Pressure Physical Examination medicine.diagnostic_test business.industry Central venous pressure Area under the curve Middle Aged medicine.disease Parasternal heave Pulmonary hypertension Logistic Models Area Under Curve Heart catheterization Hypertension Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 155(5) |
| ISSN: | 1931-3543 |
| Popis: | Background The usefulness of physical examination findings for pulmonary hypertension (PH) is not well established. The purpose of this study was to evaluate prospectively the diagnostic performance of the physical examination for detecting PH. Methods Consecutive patients undergoing right-sided heart catheterization (n = 116) were examined by an attending physician, medical resident, and medical student in a blinded fashion. Sensitivity, specificity, and positive and negative likelihood ratios (LRs) were calculated for each physical finding. Jugular venous pulsation (JVP) height was compared with right atrial pressure (RAP) by using linear regression. The association between physical findings and PH was assessed using univariate and multivariate logistic regression. Results The prevalence of PH was 87%. Only a JVP > 3 cm (positive LR, 2.5; 95% CI, 1.2-5.4) and pulmonic regurgitation murmur (specificity, 100%; 95% CI, 79%-100%) helped rule in PH. The absence of JVP > 3 cm (negative LR, 0.4; 95% CI, 0.3-0.6) and absence of loud pulmonic component of the second heart sound (negative LR, 0.5; 95% CI, 0.3-0.9) had modest usefulness in excluding PH. JVP correlated with RAP (r = 0.59; P 3 cm and a parasternal heave discriminated PH (area under the curve [AUC] = 0.75). The combination of JVP > 3 cm, heave, and peripheral edema discriminated severe PH (mean pulmonary arterial pressure ≥ 45 mm Hg; AUC = 0.82). Conclusions Individual physical examination findings have inadequate diagnostic usefulness for PH. No combination of findings can be used to exclude PH, but the presence of high JVP, peripheral edema, and parasternal heave suggests severe PH. |
| Databáze: | OpenAIRE |
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