Diagnosing and grading heart failure with tomographic perfusion lung scintigraphy: validation with right heart catheterization

Introduction: Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. The visual inspection of jugular venous pulsation (JVP) in a reclined position and measuring its height from the sternal notch has been used as a surrogate for right atrial pressure (RAP). There are no studies on the predictive value of a visible internal jugular vein (IJV) in the upright position (U 2 JVP). Hypothesis: Point of care ultrasound (POCUS) for volume assessment in the upright position is predictive of clinically significant hypervolemia. Methods: Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV and its size in comparison to the carotid artery was identified on ultrasound with the patient upright. Elevated RAP and PCWP was present if the IJV was still visible and not collapsed throughout the entirety of the respiratory cycle. Valsalva was used to confirm the position of a collapsed IJV. Results: 72 participants underwent U 2 JVP assessment on the same day prior to RHC. Average BMI was 31.9 kg/m2. The area under the curve (AUC) of U 2 JVP predicting RAP greater than 10 mmHg and PCWP of 15 mmhg or higher on RHC was 0.78 (95% CI 0.66-0.9, p<0.001), with AUC of 0.86 and 0.74 for non-obese and obese subgroups respectively, p= 0.38. The finding of a visible U 2 JVP in the upright position was 70.6 % sensitive and 85.5 % specific with a negative predictive value of 90.4% for identifying both RAP greater than 10 mmHg and PCWP equal or greater than 15 mmHg. Conclusions: The U 2 JVP is novel and pragmatic bed-side approach to the assessment of clinically significant elevated intra-cardiac pressures in our increasingly obese heart failure population.

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Pulmonary Gas Transfer Dysfunction During Exercise Right Heart Catheterization in Heart Failure with Preserved Ejection Fraction: Do Lung Diffusion Limitations Contribute to the Pathogenesis of Exercise Intolerance?

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a2072 ◽

2020 ◽

Author(s):

G.M. Stewart ◽

C.C. Fermoyle ◽

B.A. Borlaug ◽

B.D. Johnson

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Right Heart Catheterization ◽

Exercise Intolerance ◽

Heart Catheterization ◽

Gas Transfer ◽

Preserved Ejection Fraction ◽

Right Heart ◽

Lung Diffusion ◽

Diffusion Limitations

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P2473Non-invasive assessment of central venous pressure in heart failure: comparing three-dimensional echocardiography and Swan-Ganz catheter

European Heart Journal ◽

10.1093/eurheartj/ehz748.0805 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Szymczyk ◽

L J Paluszkiewicz ◽

A Costard-Jaeckle ◽

V Rudolph ◽

J F Gummert ◽

...

Keyword(s):

Heart Failure ◽

Inferior Vena ◽

Venous Pressure ◽

Three Dimensional ◽

Vena Cava ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Right Heart ◽

Cross Sectional ◽

Dimensional Echocardiography

Abstract Background Assessing hemodynamics, in particular central venous pressure (CVP) is essential in heart failure diagnostics, leading individual therapy. Hereby, invasive measurement through Swan-Ganz right heart catheterization (RHC) is considered gold standard for patient evaluation, but catheterization implies risks of invasiveness including bleeding, infection, vessel and nerve injury, as well as patient discomfort. Non-invasive methods are warranted, but no alternative technique is validated yet. Two-dimensional echocardiography (2DE) is believed to be uncertain in this approach as vena cava often shows ellipse-shapes. Therefore, this study sought to investigate standardized and breathing corrected three-dimensional inferior vena cava echocardiography (3DE) to directly compare CVP with right heart catheterization. Methods and results We prospectively included 100 consecutive heart failure patients in this study (mean age 53±12 years, body mass index 27±5, New York Heart Association functional class 2.3±0.6, left ventricular ejection fraction 34.1±12.8%, brain natriuretic peptide 658.13±974.03, 76% male), all underwent Swan-Ganz right-heart catheterization and immediately both 2DE and 3DE (Philips EPIQ 7G) of inferior vena cava. From two-dimensional data the diameter of IVC was measured perpendicularly in long and short-axis. From 3DE data a cross-sectional image of IVC was reconstructed for both vertical and horizontal diameters of IVC as well as the area of IVC. Established 2DE images revealed mean vena cava sizes of 15.9±5.9 mm, while standardized cross-sectional breathing corrected 3DE images showed diameters of 19.8±7.8 mm in longitudinal axis and 15.74±7.8 in short axis. RHC mean CVP was 9.00±5.4 mmHg and correlation of CVP and 2DE measurements failed adequate correlation (2DE 95% CI 0.19–1.61; r=0.25; p=0.312). However, 3DE axis ratio assessment correlated well with invasive CVP and showed reproducible results (3DE 95% CI 0.26–0.69; r=0.89; p<0.01). This resulted for a CVP cut point of 10 mmHg in a 89% true negative and 50% true positive correct detection. Conclusions Standardized 3DE correlates well with invasive CVP while established 2DE usual care assessment does not show reliable CVP correlation. 3DE CVP assessment may represent a more feasible and easily applicable method for CVP measurement, including absence for risks of right heart catheterization. Further studies are ongoing to validate these findings in the future.

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Variation in Right Heart Catheterization Use for Patients Hospitalized with Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2011.06.286 ◽

2011 ◽

Vol 17 (8) ◽

pp. S84-S85

Author(s):

Richard K. Cheng ◽

Haiyong Xu ◽

Carol Mangione ◽

Jose Escarce ◽

Michael Ong

Keyword(s):

Heart Failure ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Right Heart

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Right-heart failure after right heart catheterization in a patient with scleroderma and suspected pulmonary hypertension

Rheumatology International ◽

10.1007/s00296-008-0601-0 ◽

2008 ◽

Vol 28 (12) ◽

pp. 1269-1271 ◽

Cited By ~ 2

Author(s):

Gernot Keyßer ◽

Carola Schwerdt ◽

Christiane Taege

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Right Heart Failure ◽

Right Heart Catheterization ◽

Heart Catheterization ◽

Right Heart

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Abstract 13180: Ultrasound Jugular Venous Pressure Collapse Point Predicts Elevated Right Atrial Pressure on Right Heart Catheterization in Obese and Nonobese Patients

Circulation ◽

10.1161/circ.142.suppl_3.13180 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Libo Wang ◽

Jonathan Harrison ◽

Elizabeth Dranow ◽

Lillian Khor

Keyword(s):

Heart Failure ◽

Venous Pressure ◽

Right Heart Catheterization ◽

Atrial Pressure ◽

Right Atrial ◽

Right Atrial Pressure ◽

Heart Catheterization ◽

Point Of Care Ultrasound ◽

Right Heart ◽

Simplified Approach

Introduction: Accurate intravascular volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge. Visual inspection of jugular venous pulsation (JVP) is used as a surrogate for central venous pressure (CVP). Studies have shown variability and inaccuracy of the JVP exam in estimating CVP or right atrial pressure (RAP). Published methods of RAP estimation through internal jugular vein (IJV) ultrasonography are either complex or require offline analysis. We validated a simplified approach to ultrasonography of the JVP (uJVP) as a method to predict RAP. Methods: Adult patients undergoing right heart catheterization (RHC) were enrolled prior for IJV imaging with point of care ultrasound (POCUS) device, Butterfly iQ™. The IJV was identified on ultrasound with the patient reclined (head of bed between 30-45°) and followed cranially until tapering smaller than the adjacent carotid artery throughout the entirety of the respiratory cycle. The height of this collapse point from the sternal angle added to 5 centimeters was defined as ultrasound JVP (uJVP). Results: 77 participants underwent uJVP assessment on the same day prior to RHC. Average BMI was 33 kg/m 2 . The area under the curve (AUC) of uJVP and RAP greater than 10mmHg on RHC was 0.879 (95% CI 0.759-0.931, p<0.001), with AUC of 0.972 and 0.818 for non-obese and obese subgroups respectively, and AUC of 0.876 for elevated RAP and pulmonary capillary wedge pressure (PCWP). A uJVP cutoff of 9 or higher was 85% sensitive and 72% specific at identifying RAP greater than 10mmHg. Conclusion: We developed and validated a novel technique identifying the uJVP using POCUS which correlates with invasive RAP regardless of obesity. This technique predicted combined elevated left and right sided intracardiac pressures. The uJVP’s potential to enhance the diagnostic value of the bed-side examination in an increasingly obese heart failure population warrants further research.

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