Jugular vein diameter: A new player in normotensive pulmonary embolism

• Published in: Clinical imaging 2021-06, Vol.74, p.4-9
• Main Authors: Çağlar, Ahmet, Akıllı, Nazire Belgin, Köylü, Ramazan, Alpaydın, Mehmet Sertaç
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angiography; Blood pressure; Calcium-binding protein; Cardiology; Computed tomography; Confidence intervals; Echocardiography; Ejection fraction; Embolism; Embolisms; Emergency medical care; Emergency medical services; Emergency medicine; Female; Heart; Heart rate; Hospitals; Humans; Impact prediction; Jugular vein; Jugular vein diameter; Jugular Veins - diagnostic imaging; Lactic acid; Male; Medical imaging; Middle Aged; Mortality; Normal distribution; Normotensive pulmonary embolism; Patients; Performance indices; Prognosis; Prospective Studies; Pulmonary Embolism - diagnostic imaging; Pulmonary embolisms; Right ventricular dysfunction; Risk groups; Scintigraphy; Signs; Software; Statistical analysis; Thrombosis; Troponin; Ultrasonic imaging; Veins; Veins & arteries; Ventilators; Ventricle; Ventricular Dysfunction, Right
• ISSN: 0899-7071; 1873-4499
• DOI: 10.1016/j.clinimag.2020.12.034

The majority of the patients with pulmonary embolism (PE) are those with normotensive PE. Right ventricular dysfunction (RVD) and myocardial injury markers are associated with mortality although they have a low predictive impact. Here, we aim to study the performance characteristics of jugular vein diameter to predict 30-day mortality. In this prospective, observational cohort study, we included normotensive patients who were diagnosed with PE using computed tomography angiography or scintigraphy in the emergency service. The demographic characteristics, blood pressures, pulses, shock indexes, troponin and lactate levels, echocardiography findings, and internal jugular vein diameters (IJV) of the patients were recorded. Testing characteristics of IJV in predicting 30-day mortality were studied. The mean age of the 81 patients was 66.8±16.9 years and 37% of them were male. Age, shock index, lactate, RVD, PESI, and IJV diameters during inspiration and expiration were indicators for 30-day mortality. The cut-off value obtained using the ROC curve for mortality was an IJV-exp-AP of ≤8.9 mm (sensitivity,73.3%; specificity,92.4%; +LR,9.68; −LR,0.29; NPD,93.8%; PPD,68.7%; area under the curve, 0.76; 95% confidence interval, 0.65–0.84; p=0.004). IJV diameter is an indicator of 30-day mortality. It can be used to detect low-risk patients. •Clinical risk classification is important in pulmonary embolism.•It is easy to measure internal jugular vein diameter in emergency department.•IJV diameter indicates 30-day mortality in normotensive pulmonary embolism.•Internal jugular vein diameter can determine low risk patients in pulmonary embolism.