SHM Converge Scientific Abstract ePoster Gallery-The Ultrasound Hepato-Jugular Reflux Compared to Invasive Right Heart Catheterization.

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This prospective observational study across three tertiary academic hospitals evaluated whether ultrasound-measured hepato-jugular reflux (uHJR) and jugular venous pressure (uJVP) can predict invasive hemodynamic measures from right heart catheterization (RHC), especially pulmonary capillary wedge pressure (PCWP). Adult patients scheduled for RHC were enrolled, excluding those with hemodynamic instability, recent cardiac procedures, severe pulmonary hypertension, significant valvular or congenital disease, or advanced kidney/liver disease. Before catheterization, investigators measured uHJR and uJVP by ultrasound; RAP and PCWP from RHC served as reference standards.<br /><br />In 99 analyzed patients, uJVP showed moderate ability to predict elevated right atrial pressure (RAP ≥10 mmHg), with AUC 0.68, while uHJR was slightly lower at AUC 0.64; the difference was not significant. For elevated PCWP (≥15 mmHg), uHJR performed better than uJVP (AUC 0.71 vs 0.67), though this difference was also not statistically significant. However, logistic regression suggested uHJR improved prediction of PCWP more than uJVP did (adjusted OR 2.6 vs 1.2; p=0.001).<br /><br />Clinically useful thresholds were identified: uHJR of 0 cm had a negative likelihood ratio of 0.4 for elevated PCWP, and uHJR of 1.5 cm had a positive likelihood ratio of 4.3. Reproducibility was substantially better for uHJR (kappa 0.76) than for uJVP (kappa 0.11).<br /><br />Overall, ultrasound can measure hepato-jugular reflux, and uHJR appears more reproducible than uJVP. While uJVP remains useful for RAP, uHJR may offer added value for predicting elevated PCWP, especially at key cut points of 0 cm and 1.5 cm. Limitations included a small convenience sample and an indeterminate intermediate range for uHJR.

Asset Subtitle

Rolando Barajas, MPH

Meta Tag

Author List David S Weisman, Ernest Fischer, Kazi Kalam, Luis M Calderon, Rolando Barajas, MPH, Shiavax J Rao

Category Research

Concept Ultrasound Hepato-Jugular Reflux

Concept Jugular Vein Ultrasound

Concept Right Atrial Pressure

Concept Pulmonary Capillary Wedge Pressure

Concept Intra-abdominal Pressure

Distinguished Non-Finalist

Presenter Organization Georgetown University School of Medicine

Presenting Author Rolando Barajas, MPH

Track Technology in Hospital Medicine

Keywords

ultrasound hepato-jugular reflux

uHJR

jugular venous pressure

uJVP

right heart catheterization

pulmonary capillary wedge pressure

PCWP

right atrial pressure

hemodynamic prediction

reproducibility

Ultrasound Hepato-Jugular Reflux

Jugular Vein Ultrasound

Right Atrial Pressure

Pulmonary Capillary Wedge Pressure

Intra-abdominal Pressure