Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures

Sam Orde , Michel Slama (1, 2) , Konstantin Yastrebov , Anthony Mclean , Stephen Huang , Andras Nyikovics , Deirdre Murphy (3) , Geoff Gordon , Lewis Campbell , Li Tan (4) , Mate Rudas , Michael Farqharson , Nicola Stanley , Pierre Janin (5, 6) , Russell Laver , Soumya Ray , Vinodh Nanjayya , Ramsy d'Souza , Paul Healey , Bradley Wibrow , Florian Pracher , Kyle Brooks , David Clancy , Thomas Hamp , Sebastian Knudsen , Joe Mccaffrey , Godfrey Lo , Sutrisno Gunawan , Arvind Rajamani , Marek Nalos (7) , Ian Seppelt (7) , Alison Main , Yang Yang (8) , Andrew Hilton , Pranesh Jogia , Jude Bhathan , John Evans (9) , Priya Nair , Lyndal Russel , Mani Gopal , Matthew Anstey , Josh Ihle , Alvin Teo , Ben Cheung , Matt Brian , Richard Strickland , Cartan Costello , Peter Mccanny , Siew Wai , Irma Bilgram , Coll Intensive Care Med Australia

1 CHU Amiens-Picardie
2 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
3 Trinity College Dublin
4 University of Nebraska–Lincoln
5 DEVSOC - UMR Développement et Sociétés
6 IRD - Institut de Recherche pour le Développement
7 Department of Intensive Care Medicine
8 School of Mechanics and Engineering [Chengdu]
9 School of Psychology [Cardiff University]

BackgroundRight ventricle (RV) size and function assessment by echocardiography (echo) is a standard tool in the ICU. Frequently subjective assessment is performed, and guidelines suggest its utility in adequately trained clinicians. We aimed to compare subjective (visual) assessment of RV size and function by ICU physicians, with advanced qualifications in echocardiography, vs objective measurements.MethodsICU specialists with a qualification in advanced echocardiography reviewed 2D echo clips from critically ill patients on mechanical ventilation with PaO2:FiO(2) <300. Subjective assessments of RV size and function were made independently using a three-class categorical scale. Agreement (B-score) and bias (p value) were analysed using objective echo measurements. RV size assessment included RV end-diastolic area (EDA) and diameters. RV function assessment included fractional area change, S, TAPSE and RV free wall strain. Binary and ordinal analysis was performed.ResultsFifty-two clinicians reviewed 2D images from 80 patients. Fair agreement was seen with objective measures vs binary assessment of RV size (RV EDA 0.26 [p<0.001], RV dimensions 0.29 [p=0.06]) and function (RV free wall strain 0.27 [p<0.001], TAPSE 0.27 [p<0.001], S 0.29 [p<0.001], FAC 0.31 [p=0.16]). However, ordinal data analysis showed poor agreement with RV dimensions (0.11 [p=0.06]) and RV free wall strain (0.14 [p=0.16]). If one-step disagreement was allowed, agreement was good (RV dimensions 0.6 [p=0.06], RV free wall strain 0.6 [p=0.16]). Significant overestimation of severity of abnormalities was seen with subjective assessment vs RV EDA, TAPSE, S and fractional area change.ConclusionSubjective (visual) assessment of RV size and function, by ICU specialists trained in advanced echo, can be fairly reliable for the initial exclusion of significant RV pathology. It seems prudent to avoid subjective RV assessment in isolation.

Domaines: Sciences du Vivant [q-bio]

Sam Orde, Michel Slama, Konstantin Yastrebov, Anthony Mclean, Stephen Huang, et al.. Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures. Critical Care, 2019, 23, ⟨10.1186/s13054-019-2375-z⟩. ⟨hal-03584079⟩