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Assessment of Severity of Pulmonary Hypertension with Auscultation

Toru Satoh

A. Tsutsumi

Masaharu Kataoka

Yuichi Tamura

Takashi Kawakami

K. Fukuda

H. Yoshino

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Conference: 2010 International PHA Conference and Scientific Sessions

Release Date: 06.24.2010

Presentation Type: Abstracts

Satoh T, Tsutsumi A, Kataoka M, Tamura Y, Kawakami T, Fukuda K, Yoshino H. 
Kyorin University School of Medicine, Keio University School of Medicine, Tokyo, Japan

BACKGROUND: Auscultatory assessment of pulmonary hypertension (PH) has been done rarely and in this study whether severity of PH can be determined with auscultation, was investigated with an aide of phonocardiography.

METHODS: One hundred seventeen consecutive patients (mean pulmonary artery pressure: 49±13mmHg, 46 ± 15 years old) including 43 patients before the treatment were enrolled. Auscultatory findings were regarded abnormal when they were confirmed by two separate examiners with consent and recorded on phonocardiography, which was performed in the morning of the right heart catheterization (RHC). Auscultatory findings were compared with RHC data.

RESULTS: Fourth heart sound (S4) and tricuspid regurgitation (TR) were noted most in 80 and 52 patients respectively (including 30 and 21 patients before the treatment) and made the targets of study, but pulmonary second sound accentuation was noted in all patients and regarded useless to distinguish hemodynamic abnormality. Right ventricular end diastolic pressure (RVEDP) was used to compare with S4 and TR because higher RVEDP was most sensitively detected with presence of S4 or TR. Patients with both S4 and TR (RVEDP: 13.2 ± 4.6 mmHg, n=39) had significantly higher RVEDP than patients with neither of them (RVEDP: 8.5 ± 4.3 mmHg, n=24) or with S4 alone (RVEDP: 10.1 ± 3.9 mmHg, n=41). Before treatment, patients with both S4 and TR (RVEDP: 15.1 ± 3.6 mmHg, n=19) had significantly higher RVEDP than patients with S4 alone (RVEDP: 8.5 ± 2.8 mmHg, n=11), who had significantly higher RVEDP than patients with neither of them (RVEDP: 7.8 ± 1.1 mmHg, n=11).

CONCLUSIONS: PH patients with both S4 and TR are more severe than the patients with S4 alone or with neither of them. When confined to the patients before the treatment, S4 is first heard and then TR is added with worsening of PH.