Accurate assessment of the jugular venous pressure (JVP) and right atrial pressure (RAP) has relied on the same bedside examination method since 1930. While this technique provides a rough estimate of right sided pressures, it is limited by poor sensitivity and overall diagnostic inaccuracy. The internal jugular vein (IJV) is difficult to visualize in many patients and relies on an incorrect assumption that the right atrium lies 5 centimeters below the sternum. Point-of-care ultrasound (POCUS) offers an alternative method for more precisely estimating JVP and RAP. We propose a novel method of measuring the right atrial depth (RAD) using a sonographic measurement of the depth of the posterior left ventricular outflow tract as a surrogate landmark to the center of the right atrium when viewed in the parasternal long axis view. This is combined with determination if JVD was present at the supraclavicular point. Sensitivity, specificity, PPV, NPV of JVD at the supraclavicular point was 70%, 76%, 59%, 91% respectively. These values were confounded by the lack of standardization of zero reference landmarks (ZRLs) used during the right heart catheterizations. When the RAD measurement was adjusted to account for measurement error the sensitivity of JVD at supraclavicular point for elevated RAP improved to 90% with negative predictive value of 96%. This may offer a rapid and reliable method for ruling out elevated RAP and increase objectivity in our volume status assessment.

中文翻译：

---

新型床旁超声 (POCUS) 技术使 JVP 检查现代化并排除右心房压力升高

自 1930 年以来，颈静脉压 (JVP) 和右心房压 (RAP) 的准确评估一直依赖于相同的床边检查方法。虽然该技术提供了右侧压力的粗略估计，但它受限于灵敏度差和整体诊断不准确. 许多患者的颈内静脉 (IJV) 难以观察到，并且依赖于错误的假设，即右心房位于胸骨下方 5 厘米处。床旁超声 (POCUS) 为更精确地估计 JVP 和 RAP 提供了一种替代方法。我们提出了一种测量右心房深度 (RAD) 的新方法，使用左心室后流出道深度的超声测量作为在胸骨旁长轴视图中观察到的右心房中心的替代标志。这与确定锁骨上点是否存在 JVD 相结合。JVD锁骨上点的敏感性、特异性、PPV、NPV分别为70%、76%、59%、91%。由于在右心导管插入术期间使用的零参考标志 (ZRL) 缺乏标准化，这些值被混淆了。当调整 RAD 测量以解释测量误差时，锁骨上点 JVD 对升高的 RAP 的敏感性提高到 90%，阴性预测值为 96%。这可以提供一种快速可靠的方法来排除 RAP 升高并提高我们的音量状态评估的客观性。由于在右心导管插入术期间使用的零参考标志 (ZRL) 缺乏标准化，这些值被混淆了。当调整 RAD 测量以解释测量误差时，锁骨上点 JVD 对升高的 RAP 的敏感性提高到 90%，阴性预测值为 96%。这可以提供一种快速可靠的方法来排除 RAP 升高并提高我们的音量状态评估的客观性。由于在右心导管插入术期间使用的零参考标志 (ZRL) 缺乏标准化，这些值被混淆了。当调整 RAD 测量以解释测量误差时，锁骨上点 JVD 对升高的 RAP 的敏感性提高到 90%，阴性预测值为 96%。这可以提供一种快速可靠的方法来排除 RAP 升高并提高我们的音量状态评估的客观性。