POCUS-measured jugular venous pressure can accurately predict elevated central pressure

Reference

Wang L, Harrison J, Dranow E, Aliyev N, Khor L. Accuracy of ultrasound jugular venous pressure height in predicting central venous congestion. Ann Intern Med 2022;175(3):344-351.

Synopsis

These investigators examined the accuracy of point-of-care ultrasonography (POCUS) measurement of jugular venous pressure (JVP) height in predicting central venous pressure. A convenience sample of 100 adult patients undergoing right heart catheterization at 2 hospitals within an academic medical center was assembled. Two cardiology fellows trained in POCUS and one cardiology attending board-certified in echocardiography performed all assessments. Traditional visual JVP was obtained, followed by measurement of ultrasound JVP (uJVP) using a handheld POCUS device. A qualitative uJVP was obtained with the patient sitting upright (a positive finding was a distended, noncollapsible internal jugular vein). All patients then underwent right heart catheterization with measurement of right atrial pressure (RAP). Of the 100 patients, 79 were referred for right heart catheterization for heart failure or cardiomyopathy. The mean age of the study cohort was 60 years, two-thirds were men, 41% were obese, and 56% had a reduced left ventricular ejection fraction. The uJVP predicted elevated RAP (defined as > 10 mmHg) with an area under the curve of 0.84. A uJVP of 8 cm was the optimal threshold for detecting elevated RAP with a sensitivity of 73% and specificity of 79%. A positive qualitative uJVP predicted elevated RAP with a sensitivity of 55% and specificity of 95%. Even the traditional estimation of JVP by physical examination correlated well with RAP, with an area under the curve of 0.82. However, JVP by physical examination was less likely to be visualized by the examiners (63% vs 100% for uJVP).