Visual Right Ventricular Assessment in ICU: A Multicenter International Study

Area of Science:

• Cardiology
• Critical Care Medicine
• Echocardiography

Background:

• Right ventricular (RV) dysfunction is a key factor in circulatory failure among critically ill patients.
• Accurate diagnosis of RV dysfunction is crucial for effective management.
• The reliability of visual assessment for RV function in echocardiography is often debated.

Purpose of the Study:

• To evaluate the concordance between visual grading of RV systolic function, size, and septal motion.
• To compare visual assessments with standard quantitative echocardiographic parameters.
• To determine the reliability of visual assessment across different levels of echocardiography expertise.

Main Methods:

• A multicenter international prospective study involving 115 critically ill patients.
• Transthoracic echocardiography recordings were reviewed by 73 raters with varying expertise.
• Visual assessments of RV function, size, and septal motion were compared with quantitative parameters including FAC, TAPSE, S' wave, and RVFWLS.

Main Results:

• Strong agreement between visual grading and fractional area of change (FAC) was observed for experts (κ = 0.73) and intermediates (κ = 0.64).
• Moderate agreement was found for RV size and visual assessment with RV basal diameter and RV/LV area ratio.
• Low concordance was noted for septal motion and visual assessment with RV/LV basal diameter ratio.

Conclusions:

• Visual assessment of RV function by experienced raters demonstrates satisfactory concordance with guideline-based FAC.
• This finding supports the integration of visual RV function assessment into multiparametric evaluations.
• Structured educational programs can enhance the reliability of visual echocardiographic assessments.