Abstract：
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.
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.
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).
Ultrasound-assessed JV distensibility identifies patients with chronic advanced heart failure with normal RAP and better outcomes.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03874312.
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.
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).
Ultrasound-assessed JV distensibility identifies patients with chronic advanced heart failure with normal RAP and better outcomes.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03874312.
摘要：
■中心静脉压的临床评估是困难的，取决于经验，并且在慢性晚期心力衰竭患者中通常不准确。我们通过超声评估了超声评估的颈内静脉（JV）扩张性，作为一种非侵入性工具，以识别该人群中右心房压正常（RAP≤7mmHg）的患者。
■我们在连续的慢性心力衰竭患者的校准队列（N=100）和验证队列（N=101）中测量了JV扩张性，即静脉直径的Valsalva与静止比射血分数降低，并进行了肺动脉导管插入以进行晚期心力衰竭治疗检查。
■JV扩张性阈值1.6被认为是区分RAP≤7和>7mmHg患者最准确的（受试者工作特征曲线下面积，0.74[95%CI，0.64-0.84])并在验证队列中确认(接受者工作特性，0.82[95%CI，0.73-0.92]）。JV扩张性比>1.6的预测阳性值分别为0.86和0.94，在校准和验证队列中识别RAP≤7mmHg的患者。与来自具有高JV扩张性比的校准队列的患者相比(>1.6;n=42;中值RAP,4mmHg;肺毛细血管楔压,11mmHg)，具有低JV扩张比的那些(≤1.6；n=58；中值RAP，8mmHg;肺毛细血管楔压,22mmHg；两者P<0.0001）更有可能死亡或接受左心室辅助装置植入或心脏移植（2年事件发生率：42.7％对18.2％；log-rankP=0.034）。
■超声评估JV扩张性可识别出RAP正常且预后较好的慢性晚期心力衰竭患者。
■URL：https://www。clinicaltrials.gov；唯一标识符：NCT03874312。
■我们在连续的慢性心力衰竭患者的校准队列（N=100）和验证队列（N=101）中测量了JV扩张性，即静脉直径的Valsalva与静止比射血分数降低，并进行了肺动脉导管插入以进行晚期心力衰竭治疗检查。
■JV扩张性阈值1.6被认为是区分RAP≤7和>7mmHg患者最准确的（受试者工作特征曲线下面积，0.74[95%CI，0.64-0.84])并在验证队列中确认(接受者工作特性，0.82[95%CI，0.73-0.92]）。JV扩张性比>1.6的预测阳性值分别为0.86和0.94，在校准和验证队列中识别RAP≤7mmHg的患者。与来自具有高JV扩张性比的校准队列的患者相比(>1.6;n=42;中值RAP,4mmHg;肺毛细血管楔压,11mmHg)，具有低JV扩张比的那些(≤1.6；n=58；中值RAP，8mmHg;肺毛细血管楔压,22mmHg；两者P<0.0001）更有可能死亡或接受左心室辅助装置植入或心脏移植（2年事件发生率：42.7％对18.2％；log-rankP=0.034）。
■超声评估JV扩张性可识别出RAP正常且预后较好的慢性晚期心力衰竭患者。
■URL：https://www。clinicaltrials.gov；唯一标识符：NCT03874312。
