Abstract
We performed a systematic review to determine whether the physical examination can reliably assist in the diagnostic approach for patients suspected of having pulmonary hypertension (PH). Using dual extraction, two investigators independently searched PubMed, Ovid MEDLINE, Cochrane Library, and Embase for studies that compared physical examination findings with a right heart catheterization, from inception until July 10, 2021. We obtained data from four studies that evaluated physical examination findings in patients receiving a right heart catheterization to diagnose PH. Pooled diagnostic odds ratios (DOR) were calculated for right ventricular heave, a loud pulmonic component of the second heart sound (P2), jugular venous pressure (JVP) 3 cm above sternal angle, and a palpable P2.Three physical examination findings had DOR that supports the diagnosis of PH: the JVP > 3 cm above the sternal angle (5.90, 95% CI 2.57, 13.57), a loud P2 (2.91, 95% CI 1.38, 6.10), and a right ventricular heave (2.78, 95% CI 1.12, 6.89). The palpable P2 had a DOR less than one and was not able to be conclusive in diagnosing PH.Our systematic review found a small body of evidence supporting the use of physical examination tests in the diagnostic evaluation of pulmonary hypertension. The JVP > 3 cm above the sternal angle was the most accurate physical examination sign for the diagnosis of PH. Larger cohort studies using a combination of tests may shed more light on the role of the physical examination in the diagnosis and early detection of pulmonary hypertension.
Highlights
BackgroundPulmonary hypertension (PH) is a pathophysiologic condition that is most often secondary to pulmonary, cardiac, or other systemic diseases
New York Heart Association functional class and five-year survival in a cohort of 2039 patients with newly or previously diagnosed World Health Organization group 1 pulmonary hypertension (PH) were studied in the registry to evaluate early and long-term management of pulmonary arterial hypertension; group 1 PH is known as pulmonary artery hypertension [4]
We performed our systematic review on the usefulness of the physical examination in the diagnosis of pulmonary hypertension
Summary
BackgroundPulmonary hypertension (PH) is a pathophysiologic condition that is most often secondary to pulmonary, cardiac, or other systemic diseases. The World Symposium on Pulmonary Hypertension Task Force and the World Health Organization classify PH into five groups based on similar pathophysiologic and hemodynamic characteristics: (1) pulmonary arterial hypertension (PAH); (2) PH due to left heart disease; (3) PH due to lung disease and/or hypoxia; (4) PH due to pulmonary artery obstruction; and (5) PH with unclear or multifactorial mechanisms [1,2]. New York Heart Association functional class and five-year survival in a cohort of 2039 patients with newly or previously diagnosed World Health Organization group 1 PH were studied in the registry to evaluate early and long-term management of pulmonary arterial hypertension; group 1 PH is known as pulmonary artery hypertension [4]. A national registry from France confirmed that 75% of patients with group 1 PH have New York
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