title: Usefulness of the second heart sound for predicting pulmonary hypertension in patients with interstitial lung disease.
abstract: OBJECTIVE
  P2 hyperphonesis is considered to be a valuable finding in semiological diagnoses of pulmonary hypertension (PH). The aim here was to evaluate the accuracy of the pulmonary component of second heart sounds for predicting PH in patients with interstitial lung disease.
  
  
  METHODS
  Cross-sectional study at the University of Brasilia and Hospital de Base do Distrito Federal.
  
  
  METHODS
  Heart sounds were acquired using an electronic stethoscope and were analyzed using phonocardiography. Clinical signs suggestive of PH, such as second heart sound (S2) in pulmonary area louder than in aortic area; P2 > A2 in pulmonary area and P2 present in mitral area, were compared with Doppler echocardiographic parameters suggestive of PH. Sensitivity (S), specificity (Sp) and positive (LR+) and negative (LR-) likelihood ratios were evaluated.
  
  
  RESULTS
  There was no significant correlation between S2 or P2 amplitude and PASP (pulmonary artery systolic pressure) (P = 0.185 and 0.115; P= 0.13 and 0.34, respectively). Higher S2 in pulmonary area than in aortic area, compared with all the criteria suggestive of PH, showed S = 60%, Sp= 22%; LR+ = 0.7; LR- = 1.7; while P2> A2 showed S= 57%, Sp = 39%; LR+ = 0.9; LR- = 1.1; and P2 in mitral area showed: S= 68%, Sp = 41%; LR+ = 1.1; LR- = 0.7. All these signals together showed: S= 50%, Sp = 56%.
  
  
  CONCLUSIONS
  The semiological signs indicative of PH presented low sensitivity and specificity levels for clinically diagnosing this comorbidity.
authors.affiliation: Hospital de Base do Distrito Federal, Brasília, Federal District, Brazil.
authors.forename: Sandra de Barros
authors.initials: Sde B
authors.lastname: Cobra
authors.affiliation: Universidade de Brasília, Brasília, Federal District, Brazil.
authors.forename: Rayane Marques
authors.initials: RM
authors.lastname: Cardoso
authors.affiliation: School of Medicine, Universidade de Brasília, Brasília, Federal District, Brazil.
authors.forename: Marcelo Palmeira
authors.initials: MP
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006347:Heart Sounds / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology; D017563:Lung Diseases, Interstitial / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010701:Phonocardiography; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000502:physiology; D012680:Sensitivity and Specificity