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Original article
Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure
  1. Pierpaolo Pellicori1,
  2. Anna Kallvikbacka-Bennett1,
  3. Riet Dierckx1,
  4. Jufen Zhang1,
  5. Paola Putzu1,
  6. Joe Cuthbert1,
  7. Vennela Boyalla1,
  8. Ahmed Shoaib1,
  9. Andrew L Clark1,
  10. John G F Cleland1,2
  1. 1Department of Cardiology, Hull York Medical School (University of Hull), Castle Hill Hospital, Kingston upon Hull, UK
  2. 2National Heart & Lung Institute and National Institute of Health Research Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
  1. Correspondence to Dr Pierpaolo Pellicori, Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, MRTDS (Daisy) Building, Entrance 2, Castle Hill Hospital, Cottingham, Kingston upon Hull HU16 5JQ, UK; pierpaolo.pellicori{at}


Aims Jugular venous distension is a classical sign of heart failure (HF) but it can be difficult to assess clinically.

Methods and results Outpatients with HF and control subjects were assessed. Internal jugular vein diameter (JVD) was measured using a linear high-frequency ultrasound probe (10 MHz) at rest, after a Valsalva manoeuvre and during deep inspiration. JVD ratio was calculated as the maximum diameter during Valsalva to that measured at rest. 311 patients (mean age 71 years, mean left ventricular EF 42%, median (IQR) amino-terminal pro-brain natriuretic peptide 979 (441–2007) ng/L) and 66 controls were included. JVD (median and IQR range) at rest was smaller in controls (0.16 (0.14–0.20) cm) than in patients with HF (0.23 (0.17–0.33) cm; p<0.001) but similar during Valsalva (1.03 (0.90–1.16) cm vs 1.08 (0.90–1.25) cm; p=0.28). Consequently, JVD ratio was greater in controls (6.3 (4.9–7.6)) than in patients (4.5 (2.9–6.1); p<0.001). During a median follow-up of 516 (IQR 335–622) days, 48 patients (15%) with HF died or were hospitalised for HF. In multivariable models, among clinical, echocardiographic or biochemical variables, only increasing NT-proBNP and ultrasound assessment of internal jugular vein were independently associated with prognosis. Comparing top and bottom tertiles of JVD ratio (2.3 (IQR 1.7–2.9) versus 6.8 (6.1–7.7)), the tertile with lower values had a 10-fold greater risk of an adverse event (HR 10.05, 95% CI 3.07 to 32.93).

Conclusions Ultrasound assessment of the internal jugular vein identifies outpatients with HF who have a higher risk of an adverse outcome.

Clinical trial registration NCT01872299.

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