title: Detection of elevated right atrial pressure using a simple bedside ultrasound measure.
abstract: OBJECTIVE
  Accurate assessment of right atrial pressure (RAP) often requires invasive measurement. With normal RAP, Valsalva increases right internal jugular vein (RIJV) cross sectional area (CSA) 20% to 30%. With high RAP, when venous compliance is low, we hypothesized that the increase in CSA would be blunted and could be detected non-invasively with bedside ultrasound.
  
  
  RESULTS
  RIJV ultrasound images were obtained in 67 patients undergoing right heart catheterization. The median RAP at end-expiration was 7 mm Hg (interquartile range [IQR] 5-9 mm Hg) in patients with normal RAP (n = 47) versus 15 mm Hg (IQR 12-22 mm Hg) in patients with elevated RAP (n = 20). With Valsalva, the median percent change in RIJV CSA was 35% (IQR 19%-79%) versus 5% (IQR 3%-14%) for normal and high RAP, respectively. By receiver operating curve analysis, a <17% increase in RIJV CSA with Valsalva predicted elevated RAP (> or =12 mmHg) with 90% sensitivity, 74% specificity, 94% negative predictive value, and 60% positive predictive value (area under the curve 0.86, P < .001).
  
  
  CONCLUSIONS
  An increase in RIJV CSA >17% during Valsalva effectively rules out elevated RAP. This simple bedside technique may be useful to assess central venous pressure and reduce the need for invasive pressure measurement.
authors.affiliation: Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Simon
authors.forename: Dustin E
authors.initials: DE
authors.lastname: Kliner
authors.forename: John P
authors.initials: JP
authors.lastname: Girod
authors.forename: Diego
authors.initials: D
authors.lastname: Moguillansky
authors.forename: Flordeliza S
authors.initials: FS
authors.lastname: Villanueva
authors.forename: John J
authors.initials: JJ
authors.lastname: Pacella
mesh_terms: D016280:Atrial Function, Right; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002496:Central Venous Pressure; D005260:Female; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014636:Valsalva Maneuver