No abstract

Assessment of jugular venous pressure ( JVP) is a classic physical examination manoeuvre that serves as an estimate of right atrial pressure (RAP). Although JVP was rated by experts as the most important physical examination finding to monitor response to therapy in pulmonary hypertension (PH) patients [1], it has been understudied in PH. Since RAP is an accurate predictor of outcome in PH [2, 3], determining whether clinically assessed JVP (as a non-invasive surrogate for RAP) also predicts outcomes is an important, unanswered question. Since JVP can be difficult to measure on physical examination due to obesity and challenges distinguishing between carotid and jugular pulsations, ultrasound measures of JVP have been developed [4,5]. We hypothesised that: 1) JVP measurement could be more reliably obtained by ultrasound ( JVP-US) than JVP by physical examination ( JVP-exam); 2) JVP-US would correlate with same-day B-type natriuretic peptide (BNP), another non-invasive surrogate of right heart function; and 3) JVP-US would predict time to clinical worsening (TTCW).This was a prospective, observational study at a United States Pulmonary Hypertension Associationaccredited Comprehensive Care Center enrolling patients from July 2016 to April 2018, with follow-up ending April 2021. Consecutive patients from any World Symposium on Pulmonary Hypertension (WSPH) subgroup [6] were eligible for inclusion. Informed consent was obtained from each patient prior to enrolment (IRB #9403, clinicaltrials.gov NCT02873039).The REVEAL 2.0 risk score [2], a multi-parameter risk prediction score, was calculated using the most recent data from the medical record. The research team was blinded to patient's clinical status and BNP, and the treating physician was blinded to the results of the ultrasound measurement. A physical examination estimate of JVP ("JVP-exam") was performed by the treating physician by adding 5 cmH 2 O to the measured vertical height of the right internal jugular vein (IJV) V-wave above the sternal angle with the patient seated at a 45-degree angle. A handheld ultrasound device (General Electric Vscan) was used to estimate JVP in the right IJV [4] with the patient in the same position. The probe was placed in a horizontal position in the anterior triangle of the neck and then rotated 90 degrees to obtain a longitudinal view of the jugular vein. The vertical height of the IJV tapering above the sternal angle clavicle plus 5 cmH 2 O was used to estimate JVP ("JVP-US") (figure 1a). JVP measurements were taken at end-expiration.Baseline descriptive statistics were calculated and reported as mean±SD or percentages. Bland-Altman analysis was conducted to compare JVP-exam to JVP-US. Pearson correlation coefficients were calculated for both JVP-exam and JVP-US in relation to log-transformed BNP. Participants were followed prospectively for their first clinical worsening event (first occurrence of death, lung transplantation, PH-related hospitalisation, or worsening functional class (FC) with addition of PH-specific medicati...