Jugular Venous Pressure Response to Inspiration for Risk Assessment of Heart Failure

Area of Science:

• Cardiology
• Internal Medicine
• Physical Examination Techniques

Background:

• Jugular venous pressure (JVP) assessment is crucial in heart failure (HF) management.
• A simplified method of assessing JVP in the sitting position has been proposed for convenience.
• The diagnostic value of JVP assessment, particularly its inspiratory response (Kussmaul sign), for mild to moderate HF may be underestimated.

Purpose of the Study:

• To evaluate the prognostic significance of jugular venous pressure (JVP) assessed at rest and during inspiration in patients with heart failure (HF).
• To determine if a simple physical examination technique for JVP can predict adverse cardiac events in HF management.

Main Methods:

• A prospective study of 138 patients admitted for heart failure management.
• Jugular venous pressure (JVP) was assessed at rest in a sitting position before discharge.
• The response of JVP to inspiration was examined if JVP was not elevated at rest.
• Patients were followed for a composite outcome of cardiac death and HF hospitalization.

Main Results:

• 12% of patients had elevated JVP at rest, and 12% had elevated JVP only on inspiration.
• A primary outcome event occurred in 46% of patients during follow-up.
• Elevated JVP at rest (HR 3.31) and elevated JVP on inspiration (HR 2.18) were associated with significantly higher incidences of adverse cardiac events compared to normal JVP.

Conclusions:

• Elevated jugular venous pressure (JVP), whether at rest or only on inspiration, is associated with a poor prognosis in heart failure patients.
• The inspiratory response of JVP, assessed via simple physical examination, may offer a valuable new approach for managing heart failure.
• This technique provides prognostic information beyond JVP measured solely at rest.