Clinical Applicability of Assessment of Jugular Flow over the Individual Cardiac Cycle Compared with Current Ultrasound Methodology

Sisini, Francesco; Tessari, Mirko; Menegatti, Erica; Vannini, Maria Elena; Gianesini, Sergio; Tavoni, Valentina; Gadda, Giacomo; Gambaccini, M.; Taibi, Angelo; Zamboni, Paolo

doi:10.1016/j.ultrasmedbio.2016.03.002

Cited by 23 publications

(30 citation statements)

References 43 publications

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“…It is the consequence of the transmission along the veins of the atrial pressure generated by the cardiac pump in the veins of the upper part of the body. [34][35][36][37][38] Some authors compare the jugular pulsation to a barometer inserted into the atrium that measures the pressure variations in the cardiac atrium. The typical jugular venous pulse is characterized by a sequence of five waves, three positive (a, c, v) and two negative (x and y).…”

Section: Venous Compliance and Pulsatile Veinsmentioning

confidence: 99%

“…The typical jugular venous pulse is characterized by a sequence of five waves, three positive (a, c, v) and two negative (x and y). [34][35][36][37][38] When the atrium begins the contraction, signaled by the p wave of the ECG, there corresponds to the positive and higher a wave in the JVP (Figure 9). The negative peak x is the consequence of the lowering of the cardiac septum when the ventricles begin the contraction.…”

Section: Venous Compliance and Pulsatile Veinsmentioning

confidence: 99%

“…36,37 From the clip it is possible to assess something like 30 different CSA of the vein for each of the cardiac cycle. The variations of the area correspond to the JVP and in fact the ultrasonic JVP nicely reproduces the waves sequence above described, permitting also from proper calculations to assess haemodynamic parameters such as flow velocity, flow rate, gradient of pressure and venous compliance.…”

Section: Venous Compliance and Pulsatile Veinsmentioning

confidence: 99%

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Venous compliance and clinical implications

Zamboni

Tavoni

Sisini

et al. 2018

Veins and Lymphatics

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Compliance is a characteristic of every deformable system. Compliance is very clear concept in physics and mechanics but in clinics, perhaps, is not the same. However, in veins compliance fits perfectly with the function of drainage of the venous system. Volumetric increase (dV) of the content is correlated with pressure increase (dP) inside the vein according to the equation C’= dV/dP. In humans 75% of the blood is located in the venous system, primarily because the molecular components of a vein media layer is significantly more compliant to that of arteries. This property is fundamental to understanding the change in blood volume in response to a change in posture. Measurements of venous compliance in clinical practice can be done by the means of ultrasound, as well as with the plethysmography. Ultrasound methods assimilate the cross sectional area to the volume of the vein, because it reflects the blood content. Changes in cross sectional area can be reliably measured in response to a change in posture, while pressure can be derived from the hydrostatic pressure changes. Venous compliance is of paramount importance also in pulsatile veins such as the inferior or superior vena cava and the jugular veins, where high resolution ultrasound may accurately derive the cross sectional area. Clinical implications of the mechanical properties of the venous wall are extensively discussed, including the need of dedicated venous stenting, which takes into account venous compliance as the main parameter of the venous function. In addition, venous compliance is the interpretative key for a better understanding of plethysmography curves, as well as of varicose veins and of their return to normal cross sectional area following ambulatory venous pressure reduction.

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Section: Venous Compliance and Pulsatile Veinsmentioning

confidence: 99%

Section: Venous Compliance and Pulsatile Veinsmentioning

confidence: 99%

Section: Venous Compliance and Pulsatile Veinsmentioning

confidence: 99%

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Venous compliance and clinical implications

Zamboni

Tavoni

Sisini

et al. 2018

Veins and Lymphatics

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“…Speculatively, we may think that the sequential assessment of IJV CSA is less prone to error with respect to the current methodology. Quite recently, the clinical applicability of this novel method of assessment has been successfully tested, measuring the reproducibility as well as estimating the instrumental error of such a novel assessment [ 45 ]. However, we need of a wider cohort of patients in order to assess the effectiveness of this technique in categorizing abnormal cerebral venous return in relationship with the cardiac circle.…”

Section: Perspectivesmentioning

confidence: 99%

Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

Zamboni

2016

Behavioural Neurology

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Assessment of cerebral venous return is growing interest for potential application in clinical practice. Doppler ultrasound (DUS) was used as a screening tool. However, three meta-analyses of qualitative DUS protocol demonstrate a big heterogeneity among studies. In an attempt to improve accuracy, several authors alternatively measured the flow rate, based on the product of the time average velocity with the cross-sectional area (CSA). However, also the quantification protocols lacked of the necessary accuracy. The reasons are as follows: (a) automatic measurement of the CSA assimilates the jugular to a circle, while it is elliptical; (b) the use of just a single CSA value in a pulsatile vessel is inaccurate; (c) time average velocity assessment can be applied only in laminar flow. Finally, the tutorial describes alternative ultrasound calculation of flow based on the Womersley method, which takes into account the variation of the jugular CSA overtime. In the near future, it will be possible to synchronize the electrocardiogram with the brain inflow (carotid distension wave) and with the outflow (jugular venous pulse) in order to nicely have a noninvasive ultrasound picture of the brain-heart axis. US jugular venous pulse may have potential use in neurovascular, neurocognitive, neurosensorial, and neurodegenerative disorders.

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“…1,2 The flow is calculated by multiplying blood velocity in a vessel, obtained with Doppler measurements, by its cross sectional area (CSA), measured on a B-mode video-clip. [3][4][5][6] Differently from other methods used for the same purpose (for example phlebography or functional magnetic resonance imaging), such technology allows to do noninvasive, cheap and safe examinations. Several studies published in the last decades highlighted a good reproducibility among US technicians trained in investigation of cerebral venous return.…”

Section: Introductionmentioning

confidence: 99%

Conventional echo color Doppler versus ULA-OP in the assessment of venous flow model

Tavoni

Sisini

Domenico

et al. 2017

Veins and Lymphatics

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The quantification of venous flows can be obtained by multiplying cross sectional area, measured on a B-mode video-clip, by velocity values, obtained with Doppler measurements. The Doppler angle between ultrasound (US) line and blood flow requires a manual adjustment. Establishing this parameter is critical in order to calculate blood velocity. However, the operator dependency gives high variable results. It is worth noting that a new class of vector Doppler devices can enhance the accuracy and precision of measurements. Such technology uses a double US line that leads to automatically know the Doppler angle. By comparing in an in vitro model of venous flow conventional echo color Doppler (ECD) equipment with the new device, we found a better minimal difference between the latter and the nominal flow rate (20%). On the contrary, the comparison with conventional ECD showed a difference ranging between 2% and 43%, according to the possible settings of the equipment. Our study demonstrates a better accuracy of the experimental device with respect to conventional ECD in measuring the venous flow rate.

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Clinical Applicability of Assessment of Jugular Flow over the Individual Cardiac Cycle Compared with Current Ultrasound Methodology

Cited by 23 publications

References 43 publications

Venous compliance and clinical implications

Venous compliance and clinical implications

Why Current Doppler Ultrasound Methodology Is Inaccurate in Assessing Cerebral Venous Return: The Alternative of the Ultrasonic Jugular Venous Pulse

Conventional echo color Doppler versus ULA-OP in the assessment of venous flow model

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