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Chest. 2019 May;155(5):982-990. doi: 10.1016/j.chest.2019.01.035. Epub 2019 Feb 28.

A Prospective Evaluation of the Diagnostic Accuracy of the Physical Examination for Pulmonary Hypertension.

Author information

1
Section of Respirology, Department of Medicine, Calgary, AB, Canada.
2
Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada.
3
Section of Respirology, Department of Medicine, Calgary, AB, Canada; Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada. Electronic address: jcweathe@ucalgary.ca.

Abstract

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 < .001) but tended to lead to underestimation of RAP (mean bias, -3.4 cm H2O; 95% limits of agreement, -14.0 to 7.2). The presence of JVP > 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.

KEYWORDS:

diagnosis; physical examination; pulmonary hypertension

PMID:
30826305
DOI:
10.1016/j.chest.2019.01.035
[Indexed for MEDLINE]

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