Am J Med. 2024 Feb 22:S0002-9343(24)00097-4. doi: 10.1016/j.amjmed.2024.02.019. Online ahead of print.
ABSTRACT
BACKGROUND: Ultrasound can overcome barriers to visualizing the internal jugular vein, allowing jugular venous pressure and hepato-jugular reflux measurement. We aimed to determine operating characteristics of the ultrasound hepato-jugular reflux and ultrasound jugular venous pressure predicting right atrial and pulmonary capillary occlusion pressures.
METHODS: In a prospective observational cohort at three U.S. academic hospitals the hepato-jugular reflux and jugular venous pressure were measured with ultrasound before right heart catheterization. Receiver-operating curves, likelihood-ratios, and regression models were utilized to compare the ultrasound hepato-jugular reflux and ultrasound jugular venous pressure to the right atrial and pulmonary capillary occlusion pressures.
RESULTS: In 99 adults undergoing right heart catheterization, an ultrasound hepato-jugular reflux had a negative likelihood-ratio of 0.4 if zero cm and a positive likelihood-ratio of 4.3 if ≥ 1.5 cm for predicting a pulmonary capillary occlusion pressure ≥ 15 mmHg. Regression modeling predicting pulmonary capillary occlusion pressure was not only improved by including the ultrasound hepato-jugular reflux (p<0.001), it was the more impactful predictor compared to the ultrasound jugular venous pressure (adjusted OR 2.6 versus 1.2). The ultrasound hepato-jugular reflux showed substantial agreement, kappa 0.76 (95% CI 0.30 - 1.21) with poor agreement for the ultrasound jugular venous pressure, kappa 0.11 (95% CI -0.37 - 0.58).
CONCLUSION: In patients undergoing right heart catheterization, the ultrasound hepato-jugular reflux is reproducible, has modest impact on the probability of a normal pulmonary capillary occlusion pressure when zero cm, and more substantial impact on the probability of an elevated pulmonary capillary occlusion pressure when ≥ 1.5 cm.
PMID:38401676 | DOI:10.1016/j.amjmed.2024.02.019