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The abdominojugular test: technique and hemodynamic correlates
1University of Arizona College of Medicine, Tucson.
Annals of Internal Medicine
|September 15, 1988
Summary
The abdominojugular reflux test, when standardized, correlates with pulmonary arterial wedge pressure, indicating increased central blood volume. A positive test suggests pulmonary artery wedge pressure of 15 mm Hg or greater, reflecting left ventricular failure.
Area of Science:
- Cardiology
- Hemodynamics
Background:
- The abdominojugular reflux test is used to assess right atrial pressure.
- Its correlation with left ventricular function and central blood volume requires further elucidation.
Purpose of the Study:
- To determine the hemodynamic correlates of a modified abdominojugular reflux test.
- To establish the relationship between the abdominojugular test and pulmonary arterial wedge pressure.
Main Methods:
- A case series involving 86 patients undergoing right and left heart catheterization.
- Application of firm midabdominal pressure for 10 seconds, recording right atrial and pulmonary arterial wedge pressures.
- Bedside observation of jugular venous pressure changes during the maneuver.
Main Results:
- A positive abdominojugular test (increase and abrupt drop in right atrial pressure) was associated with hemodynamic evidence of left ventricular failure.
- Patients with positive tests had lower ejection fractions, lower stroke volumes, higher filling pressures, and higher pulmonary arterial and right atrial pressures.
- Pulmonary arterial wedge pressure showed the clearest separation, with positive responders having a mean of 19 +/- 3 mm Hg versus 10.5 +/- 1 mm Hg in negative responders (P < 0.001).
Conclusions:
- The standardized abdominojugular test correlates strongly with pulmonary arterial wedge pressure, reflecting increased central blood volume.
- In the absence of isolated right ventricular failure, a positive test suggests a pulmonary artery wedge pressure of 15 mm Hg or greater.
- This test serves as a valuable, non-invasive indicator of elevated pulmonary capillary pressures and left ventricular dysfunction.
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