• Libo Wang, Jonathan Harrison, Elizabeth Dranow, Nijat Aliyev, and Lillian Khor.
• Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah (L.W., J.H., E.D.).
• Ann. Intern. Med. 2022 Mar 1; 175 (3): 344-351.

BackgroundAssessment of volume status through the estimation of central venous pressure (CVP) is integral in the care of heart failure (HF). Bedside assessment is limited by obesity, variation in physical examination skills, and expertise in ultrasonography.ObjectiveTo validate the accuracy of quantitative and qualitative point-of-care ultrasonography assessment of jugular venous pressure (JVP) in predicting elevated CVP.DesignProspective observational study using convenience sampling.Setting2 U.S. academic hospitals.PatientsAdult patients undergoing right heart catheterization between 5 February 2019 and 1 March 2021.MeasurementsEstimation of the JVP height by handheld ultrasound device (uJVP), JVP by traditional physical examination, and qualitative presence of a distended uJVP in the upright position (upright-uJVP) was done before invasive measurements. Receiver-operating characteristic analysis of the uJVP was compared with invasive hemodynamics.ResultsIn 100 participants undergoing right heart catheterization for HF indications (mean age, 59.6 years; 44% with preserved ejection fraction), the uJVP in a reclined position accurately predicted elevated right atrial pressure (RAP) (>10 mm Hg), with an area under the curve of 0.84. A positive uJVP in the upright position was 94.6% specific for predicting elevated RAP.LimitationLimited examiners, only 2 centers, and convenience sampling.ConclusionPoint-of-care ultrasonography assessment of the uJVP is feasible, reproducible, and accurately predictive of elevated CVPs in patients undergoing right heart catheterization. Further investigation of clinical application of ultrasound-measured JVP seems warranted.Primary Funding SourceNone.

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