Simon et al developed a simple method to detect an elevated right atrial pressure by using ultrasound of the right internal jugular vein during a Valsalva maneuver. The authors are from the University of Pittsburgh.
Analysis: ultrasound of the right internal jugular vein
Pathophysiology: The compliance of the jugular vein is low when right atrial pressure is high.
Parameters:
(1) baseline cross sectional area of the right internal jugular vein in square mm at end-expiration
(2) cross sectional area of the right internal jugular vein during a Valsalva maneuver in square mm
percent increase in cross-sectional area during the Valsalva maneuver =
= ((area during Valsalva) - (area at baseline)) / (area at baseline * 100%
Interpretation:
• In patients with an elevated right atrial pressure (>= 12 mm Hg) the percent increase in cross-sectional area is < 17%, typically around 5%.
Performance:
• In patients with normal right atrial pressure the median increase in cross-sectional area is 35%.
• A low increase in cross-sectional area has a 90% sensitivity and 74% specificity for an elevated right atrial pressure.
• The area under the ROC curve is 0.86.
