Revisiting a classical clinical sign: Jugular venous ultrasound

Pellicori, P. , Kallvikbacka-Bennett, A., Zhang, J., Khaleva, O., Warden, J., Clark, A. L. and Cleland, J. G.F. (2014) Revisiting a classical clinical sign: Jugular venous ultrasound. International Journal of Cardiology, 170(3), pp. 364-370. (doi:10.1016/j.ijcard.2013.11.015) (PMID:24315339)

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Abstract

Background: Increased jugular venous pressure, reflecting the increased right atrial pressure, is a classical sign of heart failure (HF) but clinical assessment may be difficult. Methods: In ambulatory patients with HF and control subjects, jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, during a Valsalva manoeuvre and during deep inspiration. JVD ratio was calculated as diameter during Valsalva to that at rest. Results: 211 patients (mean age 70 years; mean left ventricular ejection fraction 43%) and 20 controls were included. JVD (median and inter-quartile [IQR] range) at rest was 0.17 (0.15–0.20) cm in controls and 0.23 (0.17–0.33) cm in patients with HF (p = 0.012), JVD ratio was 6.3 (4.3–6.8) in controls and 4.4 (2.7–5.8) in patients with HF (p = 0.001).With increasing quartiles of plasma NT-proBNP, JVD at rest rose (0.20 (0.15–0.23) cm, 0.21 (0.16–0.29) cm, 0.25 (0.18–0.35) cm and 0.34 (0.20–0.53) cm (P = < 0.001), whilst JVD ratio decreased (5.4 (4.2–6.4), 4.4 (3.5–6.3), 3.9 (2.4–5.4) and 2.8 (1.7–4.7); p = < 0.001). JVD ratio correlated with log (NT-proBNP) (r = − 0.39, p = < 0.001), LV filling pressures (E/E′, r = − 0.33, p = < 0.001) and left atrial volume (r = − 0.21, p = 0.002). In a multivariable regression model, only trans-tricuspid gradient and TAPSE were independently associated with JVD ratio (R2 = 0.27). Conclusions: Distension of the JV at rest relative to the maximum diameter during a Valsalva manoeuvre (JVD ratio) identifies patients with heart failure who have higher plasma NT-proBNP levels, right ventricular dysfunction and raised pulmonary artery pressure

Item Type:Articles
Additional Information:
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Russian Ministry of Science and Education within the FTP “R&D in priority
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fields of the S&T complex of Russia 2007–2012” under state contract
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Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Pellicori, Dr Pierpaolo
Authors: Pellicori, P., Kallvikbacka-Bennett, A., Zhang, J., Khaleva, O., Warden, J., Clark, A. L., and Cleland, J. G.F.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:International Journal of Cardiology
Publisher:Elsevier
ISSN:0167-5273
ISSN (Online):1874-1754
Published Online:13 November 2013

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