Could internal jugular vein ultrasound be useful in the assessment of patients with heart failure? A systematic review

Published: 9 May 2024
Abstract Views: 398
PDF: 110
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


Many recent studies have validated the internal jugular vein ultrasound (IJV-US) for estimating volemic status in critical patients. If research confirms its accuracy in detecting intravascular volume, congestion, and prognosis, this method could help manage heart failure (HF) because it is simple, fast, and applicable in several settings. This review examines the IJV-US’s reliability, diagnostic accuracy, and ability to predict poor outcomes for HF, as well as its correlation with surrogate congestion tests like natriuretic peptides and elevated central venous pressure (CVP). Our systematic review followed the PRISMA statement for systematic reviews and meta-analyses. Eleven studies examined the reliability and validity of IJV-US measures in predicting congestion, volume status, and prognosis in adult spontaneously breathing HF patients. We searched PubMed, Cochrane Library, and EMBASE. IJV-US measurements using Valsalva and sniffing seem more accurate for predicting congestion, volume status, high CVP, and poor prognosis. The IJV ratio in chronic HF and out-hospital patients and the absence of IJV area [cross-sectional area (CSA)] changes in acute HF (AHF) and in-hospital patients are the most validated measurements. No evidence suggests the method is reliable between and within raters. AHF patients’ IJV ratio and CSA absence appear to correlate with CVP and atrial natriuretic peptides. In conclusion, the IJV-US may be useful for managing HF patients, but more research is needed to confirm its reliability and prognostic accuracy. Develop a standard US protocol lastly.



PlumX Metrics


Download data is not yet available.


Girerd N, Seronde MF, Coiro S, et al. Integrative assessment of congestion in heart failure throughout the patient journey. JACC Heart Fail 2018;6:273-85. DOI:
Gheorghiade M, Follath F, Ponikowski P, et al. Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine. Eur J Heart Fail 2010;12:423-33. DOI:
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016;18:891-975. DOI:
Parenti N, Scalese M, Palazzi C, et al. Role of internal jugular vein ultrasound measurements in the assessment of central venous pressure in spontaneously breathing patients: a systematic review. J Acute Med 2019;9:39-48.
Pellicori P, Platz E, Dauw J, et al. Ultrasound imaging of congestion in heart failure: examinations beyond the heart. Eur J Heart Fail 2021;23:703-12. DOI:
Wang MK, Piticaru J, Kappe C, et al. Internal jugular vein ultrasound for the diagnosis of hypovolemia and hypervolemia in acutely ill adults: a systematic review and meta analysis. Intern Emerg Med 2022;17:1521-32. DOI:
Chaudhary R, Sukhi A, Simon MA, et al. Role of Internal jugular venous ultrasound in suspected or confirmed heart failure: a systematic review. J Card Fail 2022;28:639-49. DOI:
Jang T, Aubin C, Naunheim R, et al. Jugular vein ultrasound and pulmonary oedema in patients with suspected congestive heart failure. Eur J Emerg Med 2011;18:41-5. DOI:
Jang T, Aubin C, Naunheim R, et al. Jugular venous distension on ultrasound: sensitivity and specificity for heart failure in patients with dyspnea. Am J Emerg Med 2011;29:1198-202. DOI:
Pellicori P, Kallvikbacka-Bennett A, Zhang J, et al. Cleland JGF Revisiting a classical clinical sign: Jugular venous ultrasound Int J Cardiol 2014;170:364-70. DOI:
Pellicori P, Kallvikbacka-Bennett A, Dierckx R, et al. Prognostic significance of ultrasound-assessed jugular vein distensibility in heart failure. Heart 2015;101:1149-58. DOI:
Pellicori P, Parin Shah P, Cuthbert J, et al. Prevalence, pattern and clinical relevance of ultrasound indices of congestion in outpatients with heart failure. Eur J Heart Fail 2019;21:904-16. DOI:
Simon MA, Kliner DE, Girod JP, et al. Detection of elevated right atrial pressure using a simple bedside ultrasound measure. Am Heart J 2010;159:421-7. DOI:
Simon MA, Schnatz RG, Romeo JD, Pacella JJ. Bedside ultrasound assessment of jugular venous compliance as a potential point-of-care method to predict acute decompensated heart failure 30-day readmission. J Am Heart Assoc 2018;7. DOI:
Tzadok B, Shapira S, Tal-Or E. Ultrasound of jugular veins for assessment of acute dyspnea in emergency departments and for the assessment of acute heart failure. Isr Med Assoc J 2018;20:308-10.
Vaidya GN, Ghafghazi S. Correlation of internal jugular and subclavian vein diameter variation on bedside ultrasound with invasive right heart catheterization. Indian Heart J 2021;73:231-5. DOI:
Ammirati E, Marchetti D, Colombo G, et al. Estimation of right atrial pressure by ultrasound-assessed jugular vein distensibility in patients with heart failure. Circ Heart Fail 2024;17:e010973. DOI:
Albaeni A, Sharma M, Ahmad M, Khalife WI. Accurate estimation of right-filling pressure using handheld ultrasound score in patients with heart failure. Am J Med 2022;135:634-40. DOI:
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700. DOI:
Whiting PF, Rutjes AWS, Westwood ME, et al and the QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011;155:529-36. DOI:
Martindale JL, Wakai A, Collins SP, et al. Diagnosing acute heart failure in the emergency department: a systematic review and meta-analysis. Acad Emerg Med 2016;23:223-42. DOI:

How to Cite

Parenti, N., Palazzi, C., Parenti, M., & D’Addato, S. (2024). Could internal jugular vein ultrasound be useful in the assessment of patients with heart failure? A systematic review. Italian Journal of Medicine, 18(2).