Estimation of right atrial pressure by ultrasound-assessed jugular vein distensibility in patients with heart failure

Ammirati, E. et al. (2024) Estimation of right atrial pressure by ultrasound-assessed jugular vein distensibility in patients with heart failure. Circulation: Heart Failure, 17(2), e010973. (doi: 10.1161/CIRCHEARTFAILURE.123.010973) (PMID:38299348)

Abstract

BACKGROUND: Clinical evaluation of central venous pressure is difficult, depends on experience, and is often inaccurate in patients with chronic advanced heart failure. We assessed the ultrasound-assessed internal jugular vein (JV) distensibility by ultrasound as a noninvasive tool to identify patients with normal right atrial pressure (RAP ≤7 mm Hg) in this population. METHODS: We measured JV distensibility as the Valsalva-to-rest ratio of the vein diameter in a calibration cohort (N=100) and a validation cohort (N=101) of consecutive patients with chronic heart failure with reduced ejection fraction who underwent pulmonary artery catheterization for advanced heart failure therapies workup. RESULTS: A JV distensibility threshold of 1.6 was identified as the most accurate to discriminate between patients with RAP ≤7 versus >7 mm Hg (area under the receiver operating characteristic curve, 0.74 [95% CI, 0.64–0.84]) and confirmed in the validation cohort (receiver operating characteristic, 0.82 [95% CI, 0.73–0.92]). A JV distensibility ratio >1.6 had predictive positive values of 0.86 and 0.94, respectively, to identify patients with RAP ≤7 mm Hg in the calibration and validation cohorts. Compared with patients from the calibration cohort with a high JV distensibility ratio (>1.6; n=42; median RAP, 4 mm Hg; pulmonary capillary wedge pressure, 11 mm Hg), those with a low JV distensibility ratio (≤1.6; n=58; median RAP, 8 mm Hg; pulmonary capillary wedge pressure, 22 mm Hg; P<0.0001 for both) were more likely to die or undergo a left ventricular assist device implant or heart transplantation (event rate at 2 years: 42.7% versus 18.2%; log-rank P=0.034). CONCLUSIONS: Ultrasound-assessed JV distensibility identifies patients with chronic advanced heart failure with normal RAP and better outcomes.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Pellicori, Dr Pierpaolo
• Authors: Ammirati, E., Marchetti, D., Colombo, G., Pellicori, P., Gentile, P., D’Angelo, L., Masciocco, G., Verde, A., Macera, F., Brunelli, D., Occhi, L., Musca, F., Perna, E., Bernasconi, D. P., Moreo, A., Camici, P., Metra, M., Oliva, F., and Garascia, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Circulation: Heart Failure
• Publisher: Lippincott, Williams & Wilkins for American Heart Association
• ISSN: 1941-3289
• ISSN (Online): 1941-3297
• Published Online: 01 February 2024
• Copyright Holders: Copyright © 2024 American Heart Association, Inc.
• First Published: First published in Circulation: Heart Failure 17(2):e010973
• Publisher Policy: Reproduced in accordance with the publisher copyright policy