Ultrasound changes of internal jugular veins in patients with atrial fibrillation

Aim. To study changes of geometric and hemodynamic characteristics of internal jugular veins (IJVs) using ultrasound in patients with atrial fibrillation (AF). Today, we have quite a lot of data on changes in cerebral arteries. There is much less information about venous changes using such a simple and accessible method as ultrasound, and data on cerebral venous outflow in AF are insufficient.

Material and methods. This observational study included patients with permanent AF and patients with sinus rhythm and no history of arrhythmias. The AF group included 29 patients with AF, while the control group — 41 patients without arrhythmias. All patients underwent ultrasound of the following vessels: extracranial — IJV and common carotid artery (CCA), intracranial — basal vein of Rosenthal and middle cerebral artery. Arterial pressure and venous pressure (VP) in the bra­chial vein were measured.

Results. According to the clinical characteristics of VP and central VP, patients in the AF group and the control group did not differ significantly. The area of the IJV was larger in the AF group as follows: on the right — 2,1±0,66 and 1,32±0,35 cm² in the AF group and in the control group with sinus rhythm, respectively (p=0,001); on the left — 1,59±0,55 and 1,22±0,43 cm² in the group with AF and in the control group, respectively (p=0,01). Moreover, time-averaged maximum (TAMAX) and mean (TAMEAN) velocities of IJVs in the AF group were significantly lower than in patients with sinus rhythm (on the right, TAMAX was 7,86±2,32 and 12,48±6,15 cm/sec in the AF group and in the control group, respectively (p=0,01); on the left — 7,40±2,35 and 11,37±5,24 cm/sec in the AF group and in the control group, respectively (p=0,01); on the right, TAMEAN was 4,82±1,65 and 7,70±3,22 cm/sec in the AF group and in the control group, respectively (p=0,01); on the left — 4,42±1,58 and 7,25±3,10 cm/sec in the AF group and in the control group, respectively (p>0,01). However, the velocity characteristics in the AF group remained within the lower reference limit. Similar velocity values by groups were obtained regarding basal veins of Rosenthal.

Conclusion. Evaluation of the geometric and hemodynamic chara­cteristics of the IJV during a comprehensive ultrasound examination is necessary in patients with AF, since they are characterized by dilated IJV and decreased velocity parameters to lower reference limit. The ultrasound data of the IJV in patients with AF reflect the initial signs of venous outflow impairment. This can lead to an increase in peripheral resistance in the arterioles, and as a consequence, to impaired cerebral perfusion and cognitive dysfunction.

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