Clinical and hemodynamic assessment of the hepatojugular reflux

Abstract

The hepatojugular reflux (HJR) test was studied to assess the ability to clinically predict response during cardiac catheterization and to determine its significance in patients without heart failure and correlate it to their baseline hemodynamic parameters. Sixty-five patients considered to be free of heart failure undergoing routine cardiac catheterization were enrolled. The HJR test, defined as the venous pressure response to sustained abdominal compression, was performed in a standardized manner at the bedside assessing change in internal jugular venous pressure and during right-sided cardiac catheterization measuring change in right atrial pressure. For comparison a sustained increase ≥1 cm was considered positive. In 62 of 65 patients the HJR test stabilized by 15 seconds. The results during examination at the bedside agreed with those at catheterization (κ = 0.74, p < 0.001). The HJR test result correlated best with baseline mean right atrial pressure (r = 0.59) and right ventricular end-diastolic pressure (r = 0.51), and in bivariate regression analysis predicted right atrial (F (1,63)) = 32.8, R 2 = 0.34, p < 0.0001) and right ventricular end-diastolic (F (1,63) = 22, R 2 = 0.26, p < 0.0001) pressures. A positive test had high sensitivity and specificity for predicting right atrial pressure >9 mm Hg (1.0, 0.85) and right ventricular end-diastolic pressure >12 mm Hg (0.90, 0.89). It is concluded that 15 seconds is adequate for interpretation, and bedside observation predicts the response during right-sided cardiac catheterization. A positive test result in patients believed clinically free of heart failure can detect elevated right-sided cardiac pressures and correlated best to baseline mean right atrial and right ventricular end-diastolic pressures. This suggests a central role of right-sided cardiac function in determining the response.