The abdominojugular test: technique and hemodynamic correlates.

Abstract

To determine the hemodynamic correlates of a modified abdominojugular reflux test. Case series. Referral-based cardiology practice in a university hospital. Two consecutive samples of 65 (group 1) and 21 (group 2) patients having both right and left heart catheterization. Ten seconds of firm midabdominal pressure was applied by hand in all patients. In group 1 patients, right atrial pressures were recorded during this maneuver. In group 2 patients, simultaneous right atrial and pulmonary arterial wedge pressures were recorded during this maneuver. In group 2 patients, this abdominojugular test was also done at the bedside before cardiac catheterization by observing the changes in the jugular venous pressure. Positive results on an abdominojugular test, defined as an increase in the right atrial pressure during 10 seconds of firm midabdominal compression followed by an abrupt drop in pressure of at least 3 mm Hg (4 cm of blood) on pressure release, were found in patients who as a group had hemodynamic evidence of left ventricular failure. The patients with a positive response had lower left ventricular ejection fractions and stroke volumes, and higher left ventricular filling, higher mean pulmonary arterial, and higher right atrial pressures. The pulmonary arterial occluded or wedge pressures provided the clearest separation between patients with and without a positive response. The mean pulmonary arterial wedge pressure was 10.5 +/- 1 mm Hg in patients with a negative response and 19 +/- 3 mm Hg in patients with a positive response (P less than 0.001). In all but one of the group 2 patients, miabdominal pressure produced similar directional changes in both the right atrial and pulmonary arterial wedge pressures. The abdominojugular test, when done in a standardized fashion, correlates best with the pulmonary arterial wedge pressure, and therefore, is probably a reflection of an increased central blood volume. In the absence of isolated right ventricular failure, seen in some patients with right ventricular infarction, a positive abdominojugular test suggests a pulmonary artery wedge pressure of 15 mm Hg or greater.