Highlights
- •Peripheral venous pressure (PVP) can be measured easily in patients with heart failure.
- •PVP correlates strongly with right atrial pressure (RAP).
- •PVP predicted RAP better than conventional congestion assessments.
- •The predictive value of PVP should be evaluated in future studies.
ABSTRACT
Background
Accurate bedside assessment of congestion in the management of patients with heart
failure remains challenging. As a continuous conduit of circulating fluid, systemic
congestion represented by high right atrial pressure (RAP) may be reflected by peripheral
venous pressure (PVP). We evaluated the reliability of PVP measurements for assessing
congestion beyond conventional clinical assessments.
Methods and Results
We performed conventional congestion assessments and PVP measurements in 95 patients
undergoing pulmonary artery catheterization. PVP was measured via the 22-gauge peripheral
venous access placed in the upper extremity. The median RAP and PVP was 7 (interquartile
range [IQR]: 5–11) mmHg and 9 (IQR: 7–12) mmHg, respectively, with a mean bias of
1.8 ± 2.6 mmHg. PVP exhibited a strong linear correlation with RAP (Spearman R = 0.81;
P < 0.001). PVP demonstrated greater discriminatory power for both RAP ≤ 8 mmHg (area
under the curve [AUC]: 0.91 [95% confidence interval: 0.85–0.97]; sensitivity: 75%;
specificity: 87%) and RAP > 12 mmHg (AUC: 0.98 [0.95–1.00]; sensitivity: 88%; specificity:
95%) than edema, jugular venous pressure, pulmonary congestion on chest radiograph,
B-type natriuretic peptide levels, and inferior vena cava diameter.
Conclusions
PVP measured via peripheral venous access strongly correlates with invasively obtained
RAP. PVP measurements may improve current bedside assessments of congestion.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: January 15, 2022
Accepted:
November 28,
2021
Received in revised form:
November 25,
2021
Received:
November 7,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Elsevier Inc. All rights reserved.
