title: Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure.
abstract: BACKGROUND
  The independent prognostic value of elevated jugular venous pressure or a third heart sound in patients with heart failure is not well established.
  
  
  METHODS
  We performed a retrospective analysis of the Studies of Left Ventricular Dysfunction treatment trial, in which 2569 patients with symptomatic heart failure or a history of it were randomly assigned to receive enalapril or placebo. The mean (+/-SD) follow-up was 32+/-15 months. The presence of elevated jugular venous pressure or a third heart sound was ascertained by physical examination on entry into the trial. The risks of hospitalization for heart failure and progression of heart failure as defined by death from pump failure and the composite end point of death or hospitalization for heart failure were compared in patients with these findings on physical examination and patients without these findings.
  
  
  RESULTS
  Data on 2479 patients were complete and analyzed. In multivariate analyses that were adjusted for other markers of the severity of heart failure, elevated jugular venous pressure was associated with an increased risk of hospitalization for heart failure (relative risk, 1.32; 95 percent confidence interval, 1.08 to 1.62; P<0.01), death or hospitalization for heart failure (relative risk, 1.30; 95 percent confidence interval, 1.11 to 1.53; P<0.005), and death from pump failure (relative risk, 1.37; 95 percent confidence interval, 1.07 to 1.75; P<0.05). The presence of a third heart sound was associated with similarly increased risks of these outcomes.
  
  
  CONCLUSIONS
  In patients with heart failure, elevated jugular venous pressure and a third heart sound are each independently associated with adverse outcomes, including progression of heart failure. Clinical assessment for these findings is currently feasible and clinically meaningful.
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75390-9034, USA. mark.drazner@utsouthwestern.edu
authors.forename: M H
authors.initials: MH
authors.lastname: Drazner
authors.forename: J E
authors.initials: JE
authors.lastname: Rame
authors.forename: L W
authors.initials: LW
authors.lastname: Stevenson
authors.forename: D L
authors.initials: DL
authors.lastname: Dries
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D006347:Heart Sounds; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007601:Jugular Veins / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010808:Physical Examination; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014690:Venous Pressure