A Scoping Review of Validated Echocardiographic Methods for Grading Right Ventricular Dysfunction: Proposal for an...

Area of Science:

• Cardiology
• Echocardiography
• Critical Care Medicine

Background:

• Assessing right ventricular (RV) dysfunction via echocardiography (echo) is subjective due to a lack of standardized multiparametric synthesis.
• Current guidelines do not provide a clear method for combining various echo parameters for a global RV dysfunction assessment.
• This gap hinders accurate risk stratification and clinical decision-making in diverse patient populations.

Purpose of the Study:

• To conduct a scoping review to identify all multiparametric RV dysfunction scoring systems utilizing routine echocardiography parameters.
• To synthesize identified scoring systems with emerging 2025 guidelines to develop a comprehensive framework for RV dysfunction assessment.
• To provide clinicians with a structured approach for evaluating RV dysfunction using readily available echo data.

Main Methods:

• A systematic scoping review was performed using MEDLINE, EMBASE, and Web of Science databases.
• Studies proposing and validating multiparametric scoring systems for RV dysfunction in adult patients were included.
• Screening of 2,229 initial citations identified 10 observational studies across various clinical settings.

Main Results:

• Six validated echocardiographic parameters for RV dysfunction were identified: RV dilation, RV systolic dysfunction (TAPSE, S', FAC), tricuspid regurgitation, elevated right atrial pressure, RV-pulmonary artery uncoupling, and paradoxical interventricular septal motion.
• Multiparametric RV dysfunction scores demonstrated superior clinical prognostic value compared to individual echo parameters.
• The identified studies included diverse cohorts such as heart failure, cardiac surgery, and intensive care unit patients.

Conclusions:

• A novel, simple framework for assessing RV dysfunction using routine echocardiography data has been proposed.
• This framework enables the identification of high-risk or subtle RV phenotypes.
• It aims to guide clinical decision-making effectively in perioperative, intensive, and emergency care settings.