The use of jugular vene measurements to evaluate volume status in heart failure
J Vd Laken, M L Niesing, C LucasAbstract
Background
Accurate estimation of volume status in patients with heart failure (HF) is essential for optimizing treatment and improving clinical outcomes, as persistent volume overload is strongly associated with increased morbidity and mortality. Traditionally, volume assessment relies on physical examination and echocardiographic measurements such as inferior vena cava (IVC) diameter and collapsibility. However, IVC assessment may be technically challenging in certain patient populations, particularly in individuals with obesity, limited acoustic windows, or reduced cooperation. Recent studies have demonstrated that echographic measurement of the internal jugular vein (IJV) diameter, both at rest and during a Valsalva maneuver, correlates well with right atrial pressure and may serve as a reliable alternative for assessing volume status (Ammirati E. Circ Heart Fail 2024). Importantly, this technique appears easier to perform and may be less operator-dependent, making it suitable for use by healthcare professionals with varying levels of echocardiographic experience.
Purpose
The aim of this study was to evaluate the feasibility and clinical applicability of echographic measurements of the internal jugular vein diameter, with and without a Valsalva maneuver, performed by specialized heart failure nurses in both inpatient and outpatient HF settings. A diameter ratio of ≥1.6 between IJV measurements with and without Valsalva has previously been shown to be predictive of normal right atrial pressure.
Methods
In this observational study, 20 patients with a diagnosis of heart failure underwent echographic assessment of the internal jugular vein using a dedicated vascular ultrasound probe. Measurements were performed by trained heart failure nurses. IJV diameter was measured at rest and during a standardized Valsalva maneuver. Patient demographics and clinical characteristics, including HF phenotype, were collected.
Results
The mean age of the study population was 75 years; 12 patients were male. Twelve patients had HFrEF, one HFmrEF, and seven HFpEF. Adequate visualization and measurement of the internal jugular vein were successfully obtained in all patients, and the procedure was reported as easy and quick to perform. Based on IJV measurements and diameter ratios, evidence of volume overload was identified in 50% of the patients.
Conclusion
Echographic assessment of internal jugular vein diameter and collapsibility is a feasible, rapid, and easily applicable method for estimating volume status in patients with heart failure. This technique can be successfully performed in both inpatient and outpatient settings and appears to be easy to learn, even for less experienced operators such as specialized heart failure nurses. Incorporation of this method into routine heart failure care has the potential to enhance volume assessment and support more tailored management of heart failure patients.