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Assessment of the relationship between central venous pressure waveform and the severity of tricuspid valve
Shinichi Akabane1, Masaaki Asamoto2, Seiichi Azuma1
1Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan.
Insights
Central venous pressure (CVP) waveform analysis can help assess tricuspid regurgitation (TR) severity. Specific waveform features, like X descent - Y descent, show significant differences correlating with TR, aiding diagnosis.
Area of Science:
- Cardiology
- Medical Imaging
- Data Science
Background:
- The V wave height in central venous pressure (CVP) waveforms is linked to tricuspid regurgitation (TR) severity.
- The diagnostic capability of CVP waveform analysis for TR requires further confirmation.
Purpose of the Study:
- To investigate variations in CVP waveforms in relation to tricuspid regurgitation (TR) severity.
- To explore the diagnostic potential of CVP waveform features for assessing TR.
Main Methods:
- Analysis of CVP waveforms and preoperative echocardiography data from 436 patients.
- Creation of indices to quantify CVP waveform features and statistical analysis based on TR severity.
- Application of a deep learning Transformer model to analyze complex CVP waveform patterns.
Main Results:
- Significant differences were observed in C wave - Y descent, X descent - Y descent, and V wave - Y descent values across TR severity groups (p < 0.05 for two).
- The X descent - Y descent index achieved an AUC of 0.83 for differentiating none to moderate TR from severe TR.
- The Transformer model demonstrated high accuracy (0.97) on the validation dataset for TR assessment.
Conclusions:
- CVP waveform morphology exhibits significant variations that correlate with the severity of tricuspid regurgitation.
- CVP waveform analysis, particularly using deep learning, shows promise as a non-invasive tool for TR assessment.
Abstract:
Purpose The relationship between the height of the V wave in the central venous pressure (CVP) waveform and the severity of tricuspid regurgitation (TR) is well known. Their diagnostic ability is unconfirmed. This study explored CVP waveform variations with TR. Methods All patients who underwent preoperative echocardiography and CVP waveform measurements before surgery at our institution were included. Indices were created to capture each feature of the CVP waveform. The median value for each case was obtained and statistically analyzed according to the severity of TR. A deep learning technique, Transformer, was used to handle the complex features of CVP waveforms. Results This study included 436 cases. The values for C wave - Y descent, X descent - Y descent, and V wave - Y descent differed significantly in the Jonckheere-Terpstra test (p = 0.0018, 0.027, and 0.077, respectively). The area under the receiver operating characteristic (ROC) curve (AUC) for X descent - Y descent in two groups, none to moderate TR and severe TR, was 0.83 (95% confidence interval (CI) [0.68, 0.98]). For Transformer, the accuracy of the validation dataset was 0.97. Conclusions The shape of the CVP waveform varied with the severity of TR in a large dataset.
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Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...