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Sonographic assessment of jugular venous distension and B-type natriuretic peptide levels in patients with dyspnoea
  1. Timothy Jang1,2,3,
  2. Chandra Aubin2,
  3. Rosanne Naunheim2,
  4. Lawrence M Lewis2,
  5. Amy H Kaji1,3
  1. 1David Geffen School of Medicine at UCLA, Washington University School of Medicine, St Louis, Missouri, USA
  2. 2Division of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri, USA
  3. 3Harbor-UCLA Medical Center, Department of Emergency Medicine, Torrance, California, USA
  1. Correspondence to Timothy Jang, David Geffen School of Medicine at UCLA, 1000 W. Carson Street, D-9a, Torrance, CA 90509, USA; tbj{at}ucla.edu

Abstract

Background Sonographic assessment of jugular venous distension (US-JVD) has been described as a sensitive test for pulmonary oedema on chest x-ray in patients with dyspnoea, but chest x-ray may not detect all patients with raised B-type natriuretic peptide (BNP) levels.

Objective To compare US-JVD and initial BNP levels in patients with dyspnoea.

Methods This was a secondary analysis of a previously collected dataset from a prospective study of US-JVD in patients with dyspnoea due to suspected congestive cardiac failure. Initial BNP levels were obtained for each patient. The sensitivity, specificity, positive and negative predictive values (PPV and NPV), and likelihood ratios (LR) of US-JVD ≥8 cm H2O for BNP ≥500 pg/ml were calculated. The product moment correlation coefficient between US-JVD and BNP was also calculated.

Results 119 patients were included in the initial study. US-JVD ≥8 cm H2O had a sensitivity of 100% (95% CI 92% to 100%), specificity of 43% (95% CI 31% to 56%), PPV of 61% (95% CI 50% to 71%), NPV of 100% (95% CI 84% to 100%), LR+=1.75 (95% CI 1.41 to 2.17), and LR−=0 for a BNP ≥ 500 pg/ml. The Pearson correlation coefficient between US-JVD and BNP was 0.35 (95% CI 0.18 to 0.50) and the Spearman correlation coefficient was 0.73 (95% CI 0.63 to 0.80), suggesting a monotonic, but non-linear relationship between US-JVD and BNP.

Conclusion US-JVD correlates with initial BNP levels and is a sensitive test for raised BNP levels in patients with dyspnoea due to suspected congestive cardiac failure.

  • Cardiac care
  • heart failure
  • imaging
  • imaging
  • ultrasound

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Washington University School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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