Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure

Background: The independent prognostic value of elevated jugular venous pre ssure or a third heart sound in patients with heart failure is not well est ablished. Methods: We performed a retrospective analysis of the Studies of Left Ventr icular Dysfunction treatment trial, in which 2569 patients with symptomatic heart failure or a history of it were randomly assigned to receive enalapr il 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 hospitalizati on for heart failure and progression of heart failure as defined by death f rom pump failure and the composite end point of death or hospitalization fo r heart failure were compared in patients with these findings on physical e xamination and patients without these findings. Results: In multivariate analyses that were adjusted for other markers of t he severity of heart failure, elevated jugular venous pressure was associat ed with an increased risk of hospitalization for heart failure (relative ri sk, 1.32; 95 percent confidence interval, 1.08 to 1.62; P<0.01), death or h ospitalization for heart failure (relative risk, 1.30; 95 percent confidenc e interval, 1.11 to 1.53; P<0.005), and death from pump failure (relative r isk, 1.37; 95 percent confidence interval, 1.07 to 1.75; P<0.05). The prese nce of a third heart sound was associated with similarly increased risks of these outcomes. Conclusions: In patients with heart failure, elevated jugular venous pressu re and a third heart sound are each independently associated with adverse o utcomes, including progression of heart failure. Assessment for these findi ngs is clinically meaningful.