Short- and Long-Term Prognostic Implications of Jugular Venous Distension in Patients Hospitalized With Acute Heart Failure.
The present study was designed to assess the role of jugular venous distension (JVD) as a predictor of short- and long-term mortality in a "real-life" setting. The independent association between the presence of admission JVD and the 30-day, 1- and 10-year mortality was assessed among 2,212 patients hospitalized with acute heart failure (HF) who were enrolled in the Heart Failure Survey in Israel (2003). Independent predictors of JVD finding in study patients included: the presence of significant hyponatremia (odds ratio [OR] 1.48; p = 0.03), reduced left ventricular ejection fraction ([LVEF] OR 1.24; p = 0.03), anemia (OR 1.3; p = 0.01), New York Heart Association III to IV (OR 1.34; p <0.01) and age >75 years (OR 1.32; p = 0.01). The presence of JVD versus its absence at the time of HF hospitalization was associated with increased 30-day mortality (7.2% vs 4.9%, respectively; p = 0.02), 1-year (33% vs 28%, respectively; p <0.001), and greater 10-year mortality (91.8% vs 87.2%, respectively; p <0.001). Consistently, interaction term analysis demonstrated that the presence of JVD at the time of the index HF hospitalization was independently associated with a significant increased risk for 10-year mortality, with a more pronounced effect among younger patients, patients with reduced LVEF, preserved renal function, and chronic HF. In conclusion, in patients admitted with HF, JVD is associated with specific risk factors and is independently associated with increased risk of both short- and long-term mortality. These findings can be used for improved risk assessment and management of this high-risk population.
Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel. Electronic address: Fernando.Chernomordik@sheba.health.gov.il.
Fernando
F
Chernomordik
Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel; Internal Medicine D, Sheba Medical Center, Tel Hashomer, Israel.
Anat
A
Berkovitch
Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
Ehud
E
Schwammenthal
Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel.
Ilan
I
Goldenberg
Cardiac Rehabilitation Institute, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
David
D
Rott
Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yaron
Y
Arbel
Department of Medicine, Meir Medical Center, Kfar Saba, Israel.
Avishai
A
Elis
Cardiac Rehabilitation Institute, Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Robert
R
Klempfner
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology; D007557:Israel / Q000453:epidemiology; D007601:Jugular Veins / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010808:Physical Examination; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume