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Introduction: Bedside central venous pressure assessment is integral to diagnosing and managing heart failure (HF). A noninvasive point of care ultrasound (POCUS) assessment of the jugular venous pressure (uJVP) was validated as accurate in predicting elevated right atrial pressure (RAP) on right heart catheterization (RHC) in HF patients. A qualitative assessment of uJVP in the upright position (uuJVP) was found to be highly specific for detecting elevated RAP. We compared the prognostic value of the distended uuJVP and elevated RAP in predicting one-year mortality. Hypothesis: We hypothesized that a distended uuJVP was predictive of all-cause mortality. Methods: Adult patients undergoing RHC underwent uuJVP assessment with POCUS. A distended uuJVP was defined as internal jugular venous distention to at least the same size as the adjacent common carotid artery during resting inspiration and expiration (Figure 1c). Patients were examined upright at 90 degrees with their back/neck supported, and followed for one year after undergoing same day uuJVP assessment and RHC. Elevated RAP was defined as ≥10 mmHg on RHC. Kaplan Maier analysis of all-cause mortality was performed. Results: 100 patients had a uuJVP assessment prior to RHC. The distended uuJVP correlated with a mean RAP of 15 mmhg (8.3-17.1 mmHg) (Figure 1d) with a specificity of 94.6% for predicting RAP of ≥10 mmHg. Multivariate cox regression analysis showed that patients with a distended uuJVP had an increased one-year mortality (HR 3.20, 95% [CI 1.24- 8.20], p=.02) similar to those with RAP ≥10 mmHg by RHC (HR 3.21, 95% CI [1.20-8.64], p=.02) (Figure 1a/1b). Of 27 deaths, 11 (40.7%) had positive uuJVP with a specificity of 79.7%, 95% CI (69.2%-88%). Conclusions: The bedside distended uuJVP was similarly predictive of all-cause one-year mortality as elevated RAP by RHC. The clinical application of this simple, qualitative ultrasound estimate of RAP warrants further investigation.

Prolongation of the QT interval is associated with adverse cardiac events specifically Torsades de pointes (TdP). There are multiple mediations that have a known, possible, or conditional risk for prolonged QT interval, but general practitioners’ knowledge of these medications is unknown. We conducted a survey to assess internal medicine (IM) providers’ knowledge of risk factors and medications associated with prolonged QT as well as provider experience and comfort when treating patients with prolonged QT. A 17-question, anonymous survey was constructed in 2019 and distributed to IM providers and residents at a tertiary care center. Questions included demographic information, 6 Likert-scale questions gauging provider experience with prolonged QT, and 10 multiple choice clinical vignettes to assess clinical knowledge. Data was analyzed descriptively. Knowledge was assessed via clinical vignettes and compared by level of training. Forty-one responses were received out of a total of 87 possible respondents (47.1% response rate). About 70% of respondents see patients with acquired prolonged QT once monthly or more. 95% rarely see congenital prolonged QT. When presented with QTc drug issues, 73% of providers seldom or sometimes consulted pharmacy, but about half used online resources. The average correct score on the clinical vignettes was 5.59/10, with the highest scores seen in attending physicians in their first five years of practice (6.96/10). Our survey suggests that IM providers commonly encounter QT prolonging drugs. Educational efforts to improve knowledge of drug and patient risk factors for TdP may be needed.