[Heart auscultatory assessment of pulmonary artery systolic pressure].

Abstract

BACKGROUND:

The clinical assessment of pulmonary artery systolic pressure (PASP) by means of heart auscultation may be comparable to the measures obtained by Doppler echocardiography.

AIM:

To compare PASP estimated by heart auscultation and echocardiography.

MATERIAL AND METHODS:

Thirty consecutive patients aged 70 ± 16 years (68% women) were evaluated prospectively, all of whom had an echocardiogram requested by their attending physician. Echocardiographic evaluation of PASP was made by tricuspid regurgitation velocity plus right a trial pressure estimate. Two trained clinicians, blinded for the clinical history and rest of physical examination, auscultated the patients. PASP was estimated from the auscultatory intensity of the pulmonary component in comparison to the aortic component of the second heart sound and its propagation towards the apex, in accordance to a pre-established algorithm. Correlation between auscultatory and echocardiographic measures of PASP was made by Pearson test. Variability between both methods and among observers was evaluated with Bland-Altman analysis.

RESULTS:

Fifty two per cent of patients were hypertensive and 20% diabetic. Admission diagnoses were heart failure in 50% of cases, exacerbation of chronic obstructive pulmonary disease in 20%, pulmonary thromboembolism in 10% and other clinical entities in 20%. A significant correlation was found between auscultatory and echocardiographic estimation of PASP (r = 0.64, p = 0, 01). Bland-Altman analysis showed a mean difference between both determinations of 7.6 ± 7.6 mmHg. Bland-Altman analysis between both operators showed an average difference of 5.4 ± 8.4 mm Hg.

CONCLUSIONS:

Heart auscultatory evaluation allows a precise and reproducible estimation of PASP and compares favorably with echocardiographic assessment.

• Authors: Paul McNab, Pablo Castro, Hugo Verdejo, Gonzalo Martínez
• Journal: Revista medica de Chile (Rev Med Chil) Vol. 138 Issue 11 Pg. 1351-6 (Nov 2010) ISSN: 0034-9887 [Print] Chile
• Vernacular Title: Estimación auscultatoria de la presiónsistólica de arteria pulmonar: ¿Es factible?. Correlación con determinación ecocardiográfica.
• PMID: 21279246 (Publication Type: Comparative Study, Journal Article)

Topics

• Aged
• Blood Pressure (physiology)
• Echocardiography, Doppler (methods)
• Epidemiologic Methods
• Female
• Heart Auscultation (methods)
• Heart Failure (diagnostic imaging, physiopathology)
• Humans
• Hypertension, Pulmonary (diagnosis, diagnostic imaging, physiopathology)
• Male
• Pulmonary Artery (diagnostic imaging, physiopathology)
• Pulmonary Disease, Chronic Obstructive (diagnostic imaging, physiopathology)
• Systole (physiology)