TY - JOUR
T1 - Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure
AU - Drazner, Mark H.
AU - Rame, J. Eduardo
AU - Stevenson, Lynne W.
AU - Dries, Daniel L.
PY - 2001/8/23
Y1 - 2001/8/23
N2 - Background: The independent prognostic value of elevated jugular venous pressure or a third heart sound in patients with heart failure is not well established. Methods: We performed a retrospective analysis of the Studies of Left Ventricular Dysfunction treatment trial, in which 2569 patients with symptomatic heart failure or a history of it were randomly assigned to receive enalapril or placebo. The mean (±SD) follow-up was 32±15 months. The presence of elevated jugular venous pressure or a third heart sound was ascertained by physical examination on entry into the trial. The risks of hospitalization for heart failure and progression of heart failure as defined by death from pump failure and the composite end point of death or hospitalization for heart failure were compared in patients with these findings on physical examination and patients without these findings. Results: In multivariate analyses that were adjusted for other markers of the severity of heart failure, elevated jugular venous pressure was associated with an increased risk of hospitalization for heart failure (relative risk, 1.32; 95 percent confidence interval, 1.08 to 1.62; P<0.01), death or hospitalization for heart failure (relative risk, 1.30; 95 percent confidence interval, 1.11 to 1.53; P<0.005), and death from pump failure (relative risk, 1.37; 95 percent confidence interval, 1.07 to 1.75; P<0.05). The presence of a third heart sound was associated with similarly increased risks of these outcomes. Conclusions: In patients with heart failure, elevated jugular venous pressure and a third heart sound are each independently associated with adverse outcomes, including progression of heart failure. Assessment for these findings is clinically meaningful.
AB - Background: The independent prognostic value of elevated jugular venous pressure or a third heart sound in patients with heart failure is not well established. Methods: We performed a retrospective analysis of the Studies of Left Ventricular Dysfunction treatment trial, in which 2569 patients with symptomatic heart failure or a history of it were randomly assigned to receive enalapril or placebo. The mean (±SD) follow-up was 32±15 months. The presence of elevated jugular venous pressure or a third heart sound was ascertained by physical examination on entry into the trial. The risks of hospitalization for heart failure and progression of heart failure as defined by death from pump failure and the composite end point of death or hospitalization for heart failure were compared in patients with these findings on physical examination and patients without these findings. Results: In multivariate analyses that were adjusted for other markers of the severity of heart failure, elevated jugular venous pressure was associated with an increased risk of hospitalization for heart failure (relative risk, 1.32; 95 percent confidence interval, 1.08 to 1.62; P<0.01), death or hospitalization for heart failure (relative risk, 1.30; 95 percent confidence interval, 1.11 to 1.53; P<0.005), and death from pump failure (relative risk, 1.37; 95 percent confidence interval, 1.07 to 1.75; P<0.05). The presence of a third heart sound was associated with similarly increased risks of these outcomes. Conclusions: In patients with heart failure, elevated jugular venous pressure and a third heart sound are each independently associated with adverse outcomes, including progression of heart failure. Assessment for these findings is clinically meaningful.
UR - http://www.scopus.com/inward/record.url?scp=0035940039&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035940039&partnerID=8YFLogxK
U2 - 10.1056/NEJMoa010641
DO - 10.1056/NEJMoa010641
M3 - Article
C2 - 11529211
AN - SCOPUS:0035940039
SN - 0028-4793
VL - 345
SP - 574
EP - 581
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 8
ER -