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Construction of a right ventricular function assessment model in patients undergoing invasive mechanical ventilation
Jun Gao1,2, Pan Gao1, Yuanyuan Du1
1Department of Critical Care Medicine, Harrison International Peace Hospital, Hengshui, China.
Frontiers in Cardiovascular Medicine
|September 22, 2025
Summary
This study found that ultrasound indicators like IVCdmax and TAPSE correlate with Venous Excess Ultrasound (VExUS) grading in mechanically ventilated patients. A developed model using VExUS and CART effectively assesses right ventricular function and venous congestion.
Area of Science:
- Critical Care Medicine
- Cardiology
- Medical Imaging
Background:
- Assessing right ventricular (RV) function is crucial in critically ill patients, particularly those on invasive mechanical ventilation (IMV).
- Venous congestion, often assessed by the Venous Excess Ultrasound (VExUS) grading system, impacts RV performance.
- Current methods for evaluating RV function in this context may require refinement.
Purpose of the Study:
- To investigate the correlation between specific ultrasound indicators of RV function and the VExUS grading system in patients on IMV.
- To develop and validate a predictive model for RV function using VExUS grading and the Classification and Regression Tree (CART) algorithm.
Main Methods:
- A cross-sectional study involving 80 patients undergoing IMV.
- Data collected included clinical parameters, hematological indices, hemodynamic data, and ultrasound measurements (IVCdmax, TAPSE, tricuspid E-wave peak).
- Patients were stratified by VExUS grade (0 vs. ≥1). Spearman's correlation and CART analysis were used to build and validate the RV function model.
Main Results:
- Significant differences in NT-proBNP, cTnI, central venous pressure, and fluid balance were observed between VExUS groups.
- Inferior vena cava diameter (IVCdmax) showed a positive correlation (r=0.773), while TAPSE (r=-0.670) and tricuspid E-wave peak (r=-0.648) showed negative correlations with VExUS grading.
- The CART model identified IVCdmax, TAPSE, and tricuspid E-wave peak as key predictors, achieving 87.5% accuracy.
Conclusions:
- Ultrasound parameters including IVCdmax, TAPSE, and tricuspid E-wave peak are strongly correlated with VExUS grading in IMV patients.
- A RV function assessment model integrating VExUS grading and CART algorithm effectively evaluates RV performance.
- This model shows promise as a tool for identifying venous congestion in critically ill patients.
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