International practices and variability in right heart echocardiography: results from the RVNet(Work) international...

BACKGROUND: The assessment of the right heart (RH) plays a central role in the diagnosis and management of cardiovascular and pulmonary diseases. Although current guidelines have improved standardization, there is anecdotal evidence suggesting that there is significant variability in clinical practice regarding acquisition and reporting persist. OBJECTIVES: This international survey evaluated the extent of variability in echocardiographic assessment of the RH. A simple method for the standardization of RH measurements is proposed. METHODS: The international anonymous survey consisted of 68 questions with a primary focus on routine methods and measurements of RH echocardiography by transthoracic (TTE) and transesophageal (TEE) modalities. The questions were developed using a standardization framework, focused on six key areas: views and settings, phase, orientation, interface, timing and selection, as well as scaling and indexing (V-POINTS). RESULTS: The survey was available from November 2024 to February 2025. A total of 588 international respondents from various disciplines and professions responded. The majority of respondents had certification in echocardiography (74%), 34% reported 10 to 20 years of experience, 22% reported more than 20 years of experience. The 4-chamber (80%) and right ventricular (RV) focused (67%) views were most commonly used in TTE. The functional parameters included tricuspid annular plane systolic excursion (TAPSE) (80%), visual assessment (66%), RV S’ (50%), and fractional area change (FAC) (42%). RV strain and 3D metrics were less frequently used. Using TEE the mid-esophageal 4-chamber view was most commonly used (80%), RV function was mostly assessed visually, and quantification playing a secondary role (TAPSE 44% and RVFAC 34%). There was considerable variability in the definition of cardiac phases across both modalities. RV dimensions and areas were measured at the compacted region by 58% of the respondents. Scaling and indexing were not routinely used in practice. CONCLUSIONS: The survey identified significant variability in the practice of RH echocardiography. We propose a simple system (V-POINTS) which may improve standardization of image acquisition and corresponding measurements.