Accuracy of Ultrasound Jugular Venous Pressure Height in Predicting Central Venous Congestion

Link to article at PubMed

Ann Intern Med. 2021 Dec 28. doi: 10.7326/M21-2781. Online ahead of print.


BACKGROUND: Assessment of volume status through the estimation of central venous pressure (CVP) is integral in the care of heart failure (HF). Bedside assessment is limited by obesity, variation in physical examination skills, and expertise in ultrasonography.

OBJECTIVE: To validate the accuracy of quantitative and qualitative point-of-care ultrasonography assessment of jugular venous pressure (JVP) in predicting elevated CVP.

DESIGN: Prospective observational study using convenience sampling.

SETTING: 2 U.S. academic hospitals.

PATIENTS: Adult patients undergoing right heart catheterization between 5 February 2019 and 1 March 2021.

MEASUREMENTS: Estimation of the JVP height by handheld ultrasound device (uJVP), JVP by traditional physical examination, and qualitative presence of a distended uJVP in the upright position (upright-uJVP) was done before invasive measurements. Receiver-operating characteristic analysis of the uJVP was compared with invasive hemodynamics.

RESULTS: In 100 participants undergoing right heart catheterization for HF indications (mean age, 59.6 years; 44% with preserved ejection fraction), the uJVP in a reclined position accurately predicted elevated right atrial pressure (RAP) (>10 mm Hg), with an area under the curve of 0.84. A positive uJVP in the upright position was 94.6% specific for predicting elevated RAP.

LIMITATION: Limited examiners, only 2 centers, and convenience sampling.

CONCLUSION: Point-of-care ultrasonography assessment of the uJVP is feasible, reproducible, and accurately predictive of elevated CVPs in patients undergoing right heart catheterization. Further investigation of clinical application of ultrasound-measured JVP seems warranted.


PMID:34958600 | DOI:10.7326/M21-2781

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