Dr. Cunningham
Clinical question: Does measurement of ultrasound jugular venous pressure (JVP) height by ultrasound (uJVP) in the semi-upright position accurately predict right atrial pressure (RAP) based on invasive hemodynamics?
Background: Bedside JVP assessment is limited by body habitus and neck thickness. Point of care ultrasound (POCUS) assessment of inferior vena cava (IVC) diameter and collapsibility is a suboptimal test. Assessment via uJVP is reliable but has not been validated against invasive right-heart pressure measurements.
Study design: Convenience sample of adults greater than 18 undergoing right heart catheterizations.
Setting: Two academic hospitals
Synopsis: 100 patients underwent a POCUS uJVP quantitative measurement and a qualitative upright uJVP assessment (a binary assessment of elevated RAP versus normal) prior to measurement of RAP on right-heart catheterization. Ultrasound JVP was measured at the point where the internal jugular vein was smaller than the adjacent carotid artery throughout the respiratory cycle; 5 cm was added to the vertical distance to the sternal angle.
The interclass correlation coefficient was 0.97, indicating good interobserver agreement. There was a correlation between uJVP and invasive RAP measurement (r = 0.79) and the receiver-operating characteristic analysis of the uJVP predicted RAP with an area under the curve (AUC) of 0.84 (95% CI, 0.76- 0.92). Qualitative upright uJVP had a sensitivity of 54.5% and specificity of 94.6% for predicting elevated RAP. uJVP was assessed in all 100 patients whereas visual JVP was possible in 42/69 patients examined.
Bottom line: Assessment via uJVP accurately predicts RAP with good interobserver agreement.
Citation: Wang L, et al. Accuracy of ultrasound jugular venous pressure height in predicting central venous congestion [published online ahead of print, 2021 Dec 28]. Ann Intern Med. 2021 Dec 28. doi: 10.7326/M21-2781.
Dr. Cunningham is a hospitalist at Denver Health, Denver, and an assistant professor in the division of internal medicine, at the University of Colorado School of Medicine.