Key result
Serial portable ultrasound assessment of internal jugular vein compliance can act as a surrogate measure of central venous pressure in acute decompensated heart failure (RMSE = 3.18).
Why the study?
Accurate volume status assessment is crucial in ADHF, but physical examination is often inaccurate and invasive RHC carries safety and practical burdens, necessitating a reliable, non-invasive alternative to track acute CVP changes.
Does serial portable ultrasound assessment of internal jugular vein compliance accurately track acute changes in central venous pressure compared to invasive monitoring in patients with acute decompensated heart failure?
Observational (n=15)
Does serial portable ultrasound assessment of internal jugular vein compliance accurately track acute changes in central venous pressure compared to invasive monitoring in patients with acute decompensated heart failure?
Answers are grounded in this paper and cite their sources.
May support noninvasive CVP estimation in ADHF; leaves open validation in larger prospective trials before practice change.
Background: Accurate volume status assessment is crucial for the treatment of acute decompensated heart failure (ADHF). Volume status assessment by physical exam is often inaccurate, necessitating invasive measurement with right heart catheterization (RHC), which carries safety, pragmatic (scheduling, holding anticoagulants, etc.), and financial burdens. Therefore, a reliable, non-invasive, cost-effective alternative is desired. Previously, we developed an ultrasound (US) based technique to measure internal jugular vein (IJV) compliance during RHC which was used for single time point central venous pressure (CVP) predictions. We now aim to apply this technique to track acute changes in CVP during diuresis for ADHF in patients with an in-dwelling pulmonary artery catheter (PAC). Methods: We used an observational, prospective study design and recruited 15 patients from the cardiac critical unit (CCU) being treated for ADHF (systolic or diastolic) with intravenous (IV) diuretics with/without inotropic agents who underwent Swan- Ganz catheter/PAC insertion for continuous CVP monitoring. 13 of 15 patients received milrinone infusions. US images of the IJV were obtained at end-expiration and during the strain phase of Valsalva at multiple 2-3 hours intervals. Change in IJV cross-sectional area (CSA) (ImageJ) was used as a measure of IJV compliance. Patients unable to perform the Valsalva maneuver were excluded. Results: = 0.31, root mean square error = 3.18). Conclusion: Serial portable US assessment of IJV compliance can act as a surrogate measure of CVP and, therefore, can provide reliable information on acute hemodynamic changes in ADHF.
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Fatima et al. (2022) conducted an observational in Acute decompensated heart failure (ADHF) (n=15). Ultrasound assessment of internal jugular vein compliance vs. Invasive measurement with right heart catheterization (PAC) was evaluated on Acute changes in central venous pressure (CVP) (root mean square error = 3.18). Serial portable ultrasound assessment of internal jugular vein compliance can act as a surrogate measure of central venous pressure in acute decompensated heart failure (RMSE = 3.18).
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