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Chest. 2019 Feb 28. pii: S0012-3692(19)30204-1. doi: 10.1016/j.chest.2019.01.035. [Epub ahead of print]

A prospective evaluation of the diagnostic accuracy of the physical examination for pulmonary hypertension.

Author information

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

Abstract

BACKGROUND:

The utility of physical examination findings for pulmonary hypertension (PH) is not well established. The purpose of this study was to prospectively evaluate the diagnostic performance of the physical examination for detecting PH.

METHODS:

Consecutive patients undergoing right heart catheterization (n=116) were examined by an attending physician, medical resident and medical student in a blinded fashion. Sensitivity, specificity, positive and negative likelihood ratios (LR) were calculated for each physical finding. Jugular venous pulsation (JVP) height was compared to right atrial pressure (RAP) 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 (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 > 3cm (LR-0.41, 95% CI 0.27-0.63) and absence of loud P2 (LR-0.49, 95%CI 0.25-0.94) had modest utility in excluding PH. The JVP correlated with RAP (r=0.59, p<0.01) but tended to underestimate RAP (mean bias -3.4 cmH2O, 95% limits of agreement -14.0 to 7.2). The presence of JVP >3 cm and a parasternal heave discriminated patients with PH (AUC =0.75). The combination of JVP >3cm, heave, and peripheral edema discriminated severe PH (mean pulmonary artery pressure > 45mmHg, AUC 0.82).

CONCLUSIONS:

Individual physical examination findings have inadequate diagnostic utility for PH. No combination of findings can exclude PH but the presence of a high JVP, peripheral edema and a parasternal heave suggests severe PH.

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