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In Patients with Pulmonary Hypertension, Right Heart Failure is Diagnosed by Precise Estimation of Right Atrial Pressure with Inspection of the Internal Jugular Vein and Additional Use of the Hepatoju

Toru Satoh

K. Niino

Takashi Kawakami

M. Karaoke

T. Yoshikawa

S. Ogawa

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Conference: 2008 International PHA Conference and Scientific Sessions

Release Date: 06.20.2008

Presentation Type: Abstracts

Satoh T., Niino K., Kawakami T., Karaoke M.., Yoshikawa T., Ogawa S.

Keio University School of Medicine, Tokyo, Japan

BACKGROUND: This study was designed to estimate right atrial pressure (RAP) more accurately using the hepatojugular reflux (HJR) technique with inspection of the internal jugular vein (IJV).

METHODS: Eighty patients with pulmonary hypertension (average pulmonary artery pressure: 84/ 32(53) mmHg, mean RAP: 7 ± 5 mmHg) were studied. Estimated RAP was obtained by inspection of the IJV (RAPI), and by inspection of the IJV and the HJR technique (RAPH) in the early morning on the day of catheterization. The perpendicular length (PL) (cm) from the sternal angle to the highest visible point of the IJV was determined either in 45-degrees sit-up or in the recumbent position so as to visualize the IJV. PL was positive value when the IJV was observed above the sternal angle and negative when it was observed below the sternal angle. RAPI was calculated by adding 5 to PL and dividing by 1.36 to convert to a value in mmHg. RAPH was obtained in the same way, using the HJR technique. RAPI and RAPH were each compared with RAP measured by right heart catheterization (RAPC).

RESULTS: RAPH was correlated more significantly with RAPC (correlation equation: RAPC=0.98×RAPH + 2.0, r= 0.794) than RAPI with RAPC (correlation equation: RAPC=1.03×RAPI + 2.2, r= 0.698).

CONCLUSION: With inspection of the internal jugular vein combined with the hepatojugular reflux technique, right atrial pressure is well estimated and contributes to following up patients with pulmonary hypertension.