Clinical and Prognostic Significance of Positive Hepatojugular Reflux on Discharge in Acute Heart Failure: Insights from the ESCAPE Trial.
Background. There has been a decline in emphasis of the value of physical examination in heart failure (HF) with increased reliance on cardiac imaging. We aim to study the clinical and prognostic significance of positive hepatojugular reflux (HJR) on discharge in patients hospitalized with HF.Methods. Using the ESCAPE trial data, patients were compared according to the presence or absence of a positive HJR on discharge. The primary study endpoints were all-cause mortality and a composite endpoint of death, rehospitalization, and cardiac transplant during the first 6 months after discharge.Results. Among 392 patients (age: 56 years, 74% men), the HJR correlated well with clinical and objective hemodynamic markers of volume overload including right atrial pressure (RAP,P= 0.002), pulmonary capillary wedge pressure (PCWP,P= 0.006), and inferior vena cava size during inspiration (P= 0.005) and expiration (P= 0.003). The RAP had the highest AUC for predicting a positive HJR on admission (AUC: 0.655,P= 0.004) and discharge (AUC: 0.672,P= 0.001). Cox's proportional hazards analysis revealed that a positive HJR on discharge is an independent predictor of 6-month mortality (estimated hazard ratio: 1.689; 95% CI: 1.032-2.764;P= 0.037) after adjusting for age, baseline creatinine, baseline hematocrit, baseline NYHA class, chronic obstructive pulmonary disease, and the presence of tricuspid regurgitation.Conclusion. The HJR should be routinely checked in patients admitted with acute HF throughout hospitalization and especially on discharge as it serves as an important prognostic marker for postdischarge outcomes.
Internal Medicine Department, Mercy Medical Center, Clinton, IA, USA.
Hesham R
0000-0001-6857-3073
HR
Omar
Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Maya
0000-0001-5746-3135
M
Guglin
D000208:Acute Disease; D019540:Area Under Curve; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D006334:Heart Function Tests; D006349:Heart Valve Diseases / Q000150:complications; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D007601:Jugular Veins / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D011379:Prognosis; D016016:Proportional Hazards Models; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000503:physiopathology*