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

Braganza, Michael; Shaw, Jeffrey; Solverson, Kevin; Vis, Daniel; Janovcik, Juri; Varughese, Rhea; Thakrar, Mitesh V.; Hirani, Naushad; Helmersen, Doug; Weatherald, Jason

doi:10.1016/j.chest.2019.01.035

Cited by 31 publications

(30 citation statements)

References 14 publications

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“…A previous study has noted that it is possible to evaluate right ventricular diastolic function non-invasively by monitoring jugular venous pulse (JVP) [9,10]. The JVP can accurately reflect change in right atrial pressure because in contrast to other veins, the jugular veins have only one pair of valves, which are situated upward from the right atrium.…”

Section: Open Accessmentioning

confidence: 99%

Assessment of Non-Contact Measurement Using a Microwave Sensor to Jugular Venous Pulse Monitoring

Suzuki¹,

Hoshiga²,

Kotani³

et al. 2021

JBiSE

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The jugular venous pulse (JVP) waveform provides an insight into right heart function, and its assessment is important in patients with heart failure. However, the conventional pulse-transducer (contact) method for monitoring this waveform is not frequently used because it requires a high degree of skill. The aim of this study was to confirm the effectiveness of a prototype non-contact system that employs microwave radar (24 GHz, 7 mW; non-contact system) for JVP measurement. Experiments were conducted on eight healthy male volunteers (21.88 ± 0.99 years). JVP measurements were compared between the conventional contact method and the proposed non-contact method. Change in JVP waveform was measured in response to an angle of reclining in five steps from the supine position to 75˚ of elevation. The obtained JVP measurements were similar between the two methods. Because in the non-contact method the faint pulsation of the JVP is not suppressed by the pressure of a sensor placed on the skin, the prototype microwave radar system is particularly suitable for evaluating the JVP waveform.

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Section: Open Accessmentioning

confidence: 99%

Assessment of Non-Contact Measurement Using a Microwave Sensor to Jugular Venous Pulse Monitoring

Suzuki¹,

Hoshiga²,

Kotani³

et al. 2021

JBiSE

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“…After discarding duplicates, we found 179 studies that qualified for full-text review. Four studies met the initial inclusion criteria for our systematic review [15][16][17][18]. Study characteristics from the final included papers are summarized in Table 3.…”

Section: Studies Selected and Characteristicsmentioning

confidence: 99%

“…Only the study by Colman et al in 2017 had patients examined before a right heart catheterization for any reason [17]. Two of the studies were performed in PH clinics [16,18] and one in patients with advanced liver disease [15]. All patients in the four included trials received a right heart catheterization and each examiner had prior knowledge of this intervention (although blinded to the results).…”

Section: Limitationmentioning

confidence: 99%

Physical Examination for the Detection of Pulmonary Hypertension: A Systematic Review

Shellenberger

Imtiaz

Chellappa

et al. 2021

Cureus

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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.

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“…In addition, physical examinations are conducive to identifying the COVID‐19 patients with RHF. The presence of a high jugular venous pulse, peripheral oedema, and a parasternal heave is suggestive of severe PH 25 . Finally, echocardiography and computed tomography are necessary to evaluate the right heart functions in the COVID‐19 patients with suspected RHF.…”

Section: Early Diagnosis Of Right Heart Failure In Coronavirus Diseasmentioning

confidence: 99%

The overlooked chamber in coronavirus disease 2019

et al. 2020

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Coronavirus disease 2019 (COVID-19) causes a pandemic around the globe. Debilitating and even deadly complications have occurred to the millions. A recent study reported 31% of right ventricular dilation in the hospitalized COVID-19 patients, which is significantly associated with the mortality. Therefore, we sought to search for the lines of evidence in the literature that COVID-19 may contribute to right heart dysfunction. The relevant literature and data from PubMed, Embase, Cochrane Library databases, and Web of Science were searched using the MeSH terms including 'COVID-19', 'SARS-CoV-2', 'novel coronavirus pneumonia', 'novel coronavirus', 'right heart failure', 'right heart dysfunction', 'pulmonary hypertension', 'pulmonary embolism', and various combinations. The collected literature and data were sorted and summarized. Literature reports that angiotensin-converting enzyme 2 (ACE2) is the host receptor mediating the cell entry of severe acute respiratory syndrome coronavirus 2. Clinical and experimental evidence shows that loss of function of ACE2 aggravates pulmonary hypertension and gain of function of ACE2 exerts protection on cardiopulmonary circulation. Moreover, the patients with COVID-19 are more susceptible to pulmonary embolism and severe pneumonia-induced acute respiratory distress syndrome. Therefore, COVID-19 may cause right heart dysfunction by inducing pulmonary hypertension, pulmonary embolism, and acute respiratory distress syndrome. Particular attention should be paid to the function of the right heart, the overlooked chamber in COVID-19. Blood gas analysis, laboratory test of cardiac injury markers, physical examination, and echocardiography should be performed to identify right heart failure as early as possible. Once the right heart failure is confirmed, the therapeutic modalities following the guidelines of European Society of Cardiology should be employed to reduce mortality.

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

Cited by 31 publications

References 14 publications

Assessment of Non-Contact Measurement Using a Microwave Sensor to Jugular Venous Pulse Monitoring

Assessment of Non-Contact Measurement Using a Microwave Sensor to Jugular Venous Pulse Monitoring

Physical Examination for the Detection of Pulmonary Hypertension: A Systematic Review

The overlooked chamber in coronavirus disease 2019

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