Heart failure: a positive abdominojugular test correlated with a high pulmonary artery wedge pressure.

Clinical bottom line (level 4)

  1. A third of patients with heart failure had a positive abdominojugular test result.
  2. In patients with heart failure, a positive abdominojugular test correlated best with a pulmonary arterial wedge pressure of more than 15 mmHg.
  3. Patients with heart failure who had a positive response to the abdominojugular test, had a higher mean right atrial, mean pulmonary artery, mean pulmonary arterial occluded or wedge and left ventricular end diastolic pressures, than those with a negative result.
  4. Patients with a positive test had lower mean values for the left ventricular ejection fraction and lowered cardiac and stroke volume indices, than those with a negative result.
Ewy : Annals of Internal Medicine 1988; 109: 456-460
Expires November 2003

The study

Setting: referral-based cardiology practice in a university hospital, USA

65 patients (aged mean 53 years, 75% male) Both right and left heart catheterisation

Independent unblinded reference standard, applied in all patients from a consecutive appropriate spectrum.
Diagnostic test: Abdominojugular test where firm abdominal pressure was applied for 10 seconds over the centre of the patient's abdomen with the palm and slightly spread fingers of the examiner's hand. The applied pressure was approximately 20 mmHg, measured with the unrolled bladder of a standard adult blood pressure cuff, partially inflated with 6 full bulb compressions, placed between the examiner's hand and the patient's abdomen.
  • Case-series trial.

The evidence


differential diagnosis number of patients prevalence
(95% CI)
positive abdominojugular test (increase in right atrial pressure) 21 32.3%
(20.9% to 43.7%)
pulmonary artery wedge pressure = 15 mmHg 19 29.2%
(18.2% to 40.3%)

  • Mean left ventricular ejection fraction, % (positive vs negative test)- 44% vs 59% (p-value= 0.004).
  • Cardiac output, L/min (positive vs negative)- 4.80 vs 5.40 (not significant).
  • Stroke volume index, cc/beat.m ² (positive vs negative)- 34 vs 42 (p-value= 0.004).
  • Right atrial mean pressure, mmHg (positive vs negative)- 9.70 vs 6.70 (p-value= 0.003).
  • Mean pulmonary artery pressure, mmHg (positive vs negative)- 25 vs 19 p-value= 0.015).
  • Mean pulmonary artery occluded or wedge pressure, mmHg (positive vs negative)- 19.0 vs 10.5 (p-value= 0.001).
  • Left ventricular end diastolic pressure, mmHg (positive vs negative)- 18.0 vs 12.0 (p-value= 0.007).

Citation

  1. Ewy GA, : The abdominojugular test: Technique and hemodynamic correlates. Annals of Internal Medicine 1988; 109: 456-460
Contributor: Clare Wotton and Musab Hayatli, November 1999
Reviewer:

Clinical Question.
Patient left and right heart catheterisation
Intervention or Exposure abdominojugular test
Comparison pulmonary artery wedge pressure
Outcome determine the haemodynamic haemodynamic correlates