Background The independent prognostic value of elevated jugularvenous pressure or a third heart sound in patients with heartfailure is not well established.
Methods We performed a retrospective analysis of the Studiesof Left Ventricular Dysfunction treatment trial, in which 2569patients with symptomatic heart failure or a history of it wererandomly assigned to receive enalapril or placebo. The mean(±SD) follow-up was 32±15 months. The presenceof elevated jugular venous pressure or a third heart sound wasascertained by physical examination on entry into the trial.The risks of hospitalization for heart failure and progressionof heart failure as defined by death from pump failure and thecomposite end point of death or hospitalization for heart failurewere compared in patients with these findings on physical examinationand patients without these findings.
Results In multivariate analyses that were adjusted for othermarkers of the severity of heart failure, elevated jugular venouspressure was associated with an increased risk of hospitalizationfor heart failure (relative risk, 1.32; 95 percent confidenceinterval, 1.08 to 1.62; P<0.01), death or hospitalizationfor heart failure (relative risk, 1.30; 95 percent confidenceinterval, 1.11 to 1.53; P<0.005), and death from pump failure(relative risk, 1.37; 95 percent confidence interval, 1.07 to1.75; P<0.05). The presence of a third heart sound was associatedwith similarly increased risks of these outcomes.
Conclusions In patients with heart failure, elevated jugularvenous pressure and a third heart sound are each independentlyassociated with adverse outcomes, including progression of heartfailure. Assessment for these findings is clinically meaningful.(N Engl J Med 2001; 345:574-81.)
Source Information
From the Heart Failure Research Unit, Donald W. Reynolds Cardiovascular Clinical Research Center (M.H.D., J.E.R., D.L.D.), and the Division of Cardiology, Department of Internal Medicine (M.H.D., D.L.D.), University of Texas Southwestern Medical Center, Dallas; and the Cardiovascular Division, Brigham and Women's Hospital, Boston (L.W.S).
Address reprint requests to Dr. Drazner at UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9034, or at mark.drazner{at}utsouthwestern.edu.
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