Clinical value of ultrasound combined with diaphragmatic excursion assessment in evaluating right ventricular
Yu Sun1, Xuejing Liu2, Yuting Bi3
1Intensive Care Unit, Hongqi Hospital Affiliated to Mudanjiang Medical University, No. 5 Tongxiang Street, Aimin District, Mudanjiang, Heilongjiang, 157000, China.
Background:
Sepsis-induced myocardial injury often leads to right ventricular dysfunction (RVD), which worsens outcomes. Current RVD assessment methods are limited, and the role of diaphragmatic excursion (DE) remains understudied.
Objective:
To evaluate the clinical utility of ultrasound combined with DE in assessing RVD in sepsis patients and validate its feasibility in primary care.
Methods:
This retrospective study included 80 sepsis patients (40 RVD, 40 non-RVD) admitted from January 2022 to January 2025. Right ventricular dysfunction (RVD) was defined as meeting at least two of the following criteria: tricuspid annular plane systolic excursion (TAPSE) < 17 mm, right ventricular fractional area change (RVFAC) < 35%, or peak S' wave velocity < 9.5 cm/s. Right ventricular function [DE, tricuspid annular plane systolic excursion (TAPSE), and right ventricular fractional area change (RVFAC)], inflammatory markers [procalcitonin (PCT), interleukin-6 (IL-6), lactate], and clinical outcomes were analyzed using correlation, regression, and receiver operating characteristic (ROC) curve analyses.
Results:
The RVD group showed significantly lower DE, TAPSE, and RVFAC but higher IL-6, lactate, and PCT (P < 0.05). These patients required more mechanical ventilation and vasopressors, had longer ICU stays, and higher 28-day mortality (P < 0.05). DE correlated strongly with TAPSE (r = 0.655) and RVFAC (r = 0.612) (P < 0.001). Multivariate analysis identified DE (OR = 0.258) as independent RVD risk factors (P < 0.05). DE alone predicted RVD with an AUC of 0.885, while the combined model (DE+TAPSE+RVFAC) achieved an AUC of 0.990. Low DE was associated with poorer 28-day survival (P < 0.05).
Conclusion:
Ultrasound combined with DE effectively assesses RVD in sepsis, with the combined model outperforming single parameters. This approach shows potential feasibility for primary care implementation with standardized protocols and targeted training.
Clinical Trial Registration:
Not applicable.
