title: Sonographic assessment of jugular venous distension and B-type natriuretic peptide levels in patients with dyspnoea.
abstract: BACKGROUND
  Sonographic assessment of jugular venous distension (US-JVD) has been described as a sensitive test for pulmonary oedema on chest x-ray in patients with dyspnoea, but chest x-ray may not detect all patients with raised B-type natriuretic peptide (BNP) levels.
  
  
  OBJECTIVE
  To compare US-JVD and initial BNP levels in patients with dyspnoea.
  
  
  METHODS
  This was a secondary analysis of a previously collected dataset from a prospective study of US-JVD in patients with dyspnoea due to suspected congestive cardiac failure. Initial BNP levels were obtained for each patient. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and likelihood ratios (LR) of US-JVD ≥8 cm H(2)O for BNP ≥500 pg/ml were calculated. The product moment correlation coefficient between US-JVD and BNP was also calculated.
  
  
  RESULTS
  119 patients were included in the initial study. US-JVD ≥8 cm H(2)O had a sensitivity of 100% (95% CI 92% to 100%), specificity of 43% (95% CI 31% to 56%), PPV of 61% (95% CI 50% to 71%), NPV of 100% (95% CI 84% to 100%), LR+=1.75 (95% CI 1.41 to 2.17), and LR-=0 for a BNP ≥ 500 pg/ml. The Pearson correlation coefficient between US-JVD and BNP was 0.35 (95% CI 0.18 to 0.50) and the Spearman correlation coefficient was 0.73 (95% CI 0.63 to 0.80), suggesting a monotonic, but non-linear relationship between US-JVD and BNP.
  
  
  CONCLUSIONS
  US-JVD correlates with initial BNP levels and is a sensitive test for raised BNP levels in patients with dyspnoea due to suspected congestive cardiac failure.
authors.affiliation: David Geffen School of Medicine at UCLA, 1000 W. Carson Street, D-9a, Torrance, CA 90509, USA. tbj@ucla.edu
authors.forename: Timothy
authors.initials: T
authors.lastname: Jang
authors.forename: Chandra
authors.initials: C
authors.lastname: Aubin
authors.forename: Rosanne
authors.initials: R
authors.lastname: Naunheim
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Lewis
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
mesh_terms: D000368:Aged; D004108:Dilatation, Pathologic / Q000097:blood / Q000000981:diagnostic imaging; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
chemical_list: D020097:Natriuretic Peptide, Brain