title: Revisiting a classical clinical sign: jugular venous ultrasound.
abstract: BACKGROUND
  Increased jugular venous pressure, reflecting the increased right atrial pressure, is a classical sign of heart failure (HF) but clinical assessment may be difficult.
  
  
  METHODS
  In ambulatory patients with HF and control subjects, jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, during a Valsalva manoeuvre and during deep inspiration. JVD ratio was calculated as diameter during Valsalva to that at rest.
  
  
  RESULTS
  211 patients (mean age 70 years; mean left ventricular ejection fraction 43%) and 20 controls were included. JVD (median and inter-quartile [IQR] range) at rest was 0.17 (0.15-0.20) cm in controls and 0.23 (0.17-0.33) cm in patients with HF (p=0.012), JVD ratio was 6.3 (4.3-6.8) in controls and 4.4 (2.7-5.8) in patients with HF (p=0.001).With increasing quartiles of plasma NT-proBNP, JVD at rest rose (0.20 (0.15-0.23) cm, 0.21 (0.16-0.29) cm, 0.25 (0.18-0.35) cm and 0.34 (0.20-0.53) cm (P=<0.001), whilst JVD ratio decreased (5.4 (4.2-6.4), 4.4 (3.5-6.3), 3.9 (2.4-5.4) and 2.8 (1.7-4.7); p=<0.001). JVD ratio correlated with log (NT-proBNP) (r=-0.39, p=<0.001), LV filling pressures (E/E', r=-0.33, p=<0.001) and left atrial volume (r=-0.21, p=0.002). In a multivariable regression model, only trans-tricuspid gradient and TAPSE were independently associated with JVD ratio (R(2)=0.27).
  
  
  CONCLUSIONS
  Distension of the JV at rest relative to the maximum diameter during a Valsalva manoeuvre (JVD ratio) identifies patients with heart failure who have higher plasma NT-proBNP levels, right ventricular dysfunction and raised pulmonary artery pressure.
authors: Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK. Electronic address: pierpaolo.pellicori@hey.nhs.uk.
authors: Pierpaolo
authors: P
authors: Pellicori
authors: Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors: Anna
authors: A
authors: Kallvikbacka-Bennett
authors: Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors: Jufen
authors: J
authors: Zhang
authors: Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors: Olga
authors: O
authors: Khaleva
authors: Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors: John
authors: J
authors: Warden
authors: Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors: Andrew L
authors: AL
authors: Clark
authors: Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull, HU16 5JQ, UK.
authors: John G F
authors: JG
authors: Cleland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016280:Atrial Function, Right / Q000502:physiology; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000502:physiology; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D014463:Ultrasonography / Q000379:methods*; D014636:Valsalva Maneuver / Q000502:physiology; D014690:Venous Pressure / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology
keywords: Chronic heart failure; Echocardiography; Jugular vein ultrasound; Jugular venous pressure