Pierpaolo Pellicori1, Anna Kallvikbacka-Bennett2, Jufen Zhang2, Olga Khaleva2, John Warden2, Andrew L Clark2, John G F Cleland2. 1. Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK. Electronic address: pierpaolo.pellicori@hey.nhs.uk. 2. Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
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 (R(2)=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.
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 (R(2)=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.
Authors: Pierpaolo Pellicori; Anil C Joseph; Jufen Zhang; Elena Lukaschuk; Nasser Sherwi; Christos V Bourantas; Huan Loh; Andrew L Clark; John Gf Cleland Journal: Clin Res Cardiol Date: 2015-04-23 Impact factor: 5.460
Authors: Eva M Boorsma; Jozine M Ter Maaten; Kevin Damman; Wilfried Dinh; Finn Gustafsson; Steven Goldsmith; Daniel Burkhoff; Faiez Zannad; James E Udelson; Adriaan A Voors Journal: Nat Rev Cardiol Date: 2020-05-15 Impact factor: 32.419
Authors: Pierpaolo Pellicori; Alessia Urbinati; Jufen Zhang; Anil C Joseph; Pierluigi Costanzo; Elena Lukaschuk; Alessandro Capucci; John G F Cleland; Andrew L Clark Journal: Clin Cardiol Date: 2018-01-23 Impact factor: 2.882
Authors: Pierpaolo Pellicori; Elke Platz; Jeroen Dauw; Jozine M Ter Maaten; Pieter Martens; Emanuele Pivetta; John G F Cleland; John J V McMurray; Wilfried Mullens; Scott D Solomon; Faiez Zannad; Luna Gargani; Nicolas Girerd Journal: Eur J Heart Fail Date: 2020-11-23 Impact factor: 15.534
Authors: Luca Mesin; Stefano Albani; Piero Policastro; Paolo Pasquero; Massimo Porta; Chiara Melchiorri; Gianluca Leonardi; Carlo Albera; Paolo Scacciatella; Pierpaolo Pellicori; Davide Stolfo; Andrea Grillo; Bruno Fabris; Roberto Bini; Alberto Giannoni; Antonio Pepe; Leonardo Ermini; Stefano Seddone; Gianfranco Sinagra; Francesco Antonini-Canterin; Silvestro Roatta Journal: Front Cardiovasc Med Date: 2022-01-21