Abstract 16212: Ultrasound Jugular Venous Pulsation Outperforms Visual Assessment and Ivc Collapsibility for Central Venous Pressures in Obese Patients

Abstract

Introduction: Accurate volume status assessment is central to heart failure management, but current non-invasive bedside techniques remain a challenge, particularly in obese patients. Studies have shown variability and inaccuracy of the jugular venous pulse (JVP) exam in estimating right atrial pressure (RAP). Hypothesis: The accuracy of POCUS imaging of the JVP (uJVP) is preserved in obesity. Methods: Prior to undergoing right heart catheterization (RHC), subjects were enrolled for internal jugular vein imaging with a POCUS device, Butterfly iQ™. The vJVP was identified by traditional examination technique along with pIVC (an IVC>2.1 cm and <50% collapsible was considered greater or equal to 10mmHg in RAP). The IJV was identified by POCUS 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 uJVP. Results: 41 participants, 24 of whom were obese (BMI > 30 kg/m2), underwent vJVP, pIVC diameter, and uJVP assessments prior to RHC. The receiver operator curve (ROC) or Area under the Curve (AUC) was robust for uJVP and did not significantly differ between non-obese and obese participants (AUC=0.923 and AUC=0.852 respectively) in predicting RAP >=10mmHg. AUC decreased significantly with obesity for vJVP. The AUC was modest for pIVC in the non-obese, but performed poorly in obesity (Figure 1B, 1C). Conclusions: This is the first comparative study of bedside, non-invasive methods of volume assessment. The accuracy of vJVP and pIVC deteriorated with obesity, whereas the uJVP, maintained good predictive value irrespective of obesity. The novel uJVP is a promising bed-side tool for volume assessment in the obesity and warrants further study.