Remote video assessment of jugular venous pressure feasible
Remote video assessment of jugular venous pressure (JVP) is feasible and comparable to bedside JVP assessment, providing estimates that are significantly correlated with invasively measured right atrial pressure (RAP), a prospective observational study has shown.
Among 28 patients (mean age, 65 years; male, 75 percent) with HF with reduced ejection fraction who each underwent one bedside JVP assessment and up to four remote video JVP assessments using social media apps, the R2 value between bedside JVP and RAP was comparable to that between remote JVP and RAP (0.521 vs 0.504). [JAMA Cardiol 2020, doi: 10.1001/jamacardio.2020.2339]
“The JVP estimates and RAP were both ≥10 mm Hg or both <10 mm Hg in 93 percent of bedside assessments and 89 percent of remote video assessments,” reported lead investigator, Dr Mark Drazner of the University of Texas Southwestern Medical Center, Dallas, Texas, US.
In the study, JVP assessments were performed by advanced HF cardiologists. JVP could be estimated in 97 percent of the 63 remote evaluations attempted. However, remote evaluators reported significantly lower confidence levels than bedside evaluators (p<0.001). According to the investigators, the lower confidence may be secondary to less familiarity with remote video assessment or inability to perform manoeuvres such as palpitation.
“JVP is the most reliable bedside marker of volume status in HF patients,” said Drazner. “Evaluation of clinical congestion enables as-needed adjustment of medications as well as assessment of prognosis. As such, clinical congestion should be evaluated at each encounter and remains central in the care of HF patients.”
With the rapid increase in adoption of telehealth during the coronavirus disease 2019 (COVID-19) pandemic, these findings may be useful for HF specialists, although a larger study is needed to provide reliable estimates of the diagnostic utility of remote video evaluation of JVP for RAP assessment.