Visual assessment of right ventricular function by echocardiography: how good are we?

Abstract

The complex anatomy and physiology of the right ventricle (RV) is a major limitation of visual echocardiographic gradation of RV systolic function (RVF). The aim of this study was to compare visual assessment (“eyeballing”) of RVF with gold standard magnetic resonance imaging (MRI)-derived right ventricular ejection fraction (RVEF). Medical professionals from a range of clinical settings and with varying degrees of echocardiography experience were recruited via an online ultrasound teaching platform. In an anonymized web-based test, participants graded RVF in 10 patients with varying degrees of RVF via “eyeballing” of an RV-focused four-chamber view. Two skills were evaluated: (1) ability to differentiate between normal and reduced RVF; and (2) ability to determine the correct degree of RV systolic dysfunction. A total of 868 participants from 99 countries were included. For detection of reduced RVF (MRI-RVEF < 50%), sensitivity was 97.1%, 96,8%, 96.5%, and 95.8% and specificity was 55.7%, 52.8%, 54.6%, and 42.5% for the expert, advanced, intermediate, and beginner groups, respectively. For determination of the correct degree of RV dysfunction, even experienced examiners assigned a diagnosis that was discordant with MRI in > 40% of cases. In the present cohort, “eyeballing” was associated with excellent sensitivity but poor specificity in terms of differentiation between normal and abnormal RVF. Even among experts, classification of the degree of RV dysfunction was imprecise. In accordance with current guidelines, the present data suggest that “eyeballing” should be combined with evaluation of other echocardiographic parameters of RVF.

Respiratory Variations in Peak Peripheral Artery Velocities and Waveforms for Rapid Assessment of Fluid Responsiveness in Traumatic Shock Patients

“…In contrast to Jozwiak’s recommendation, the waveform changes that can be visually observed (“eyeballing”) can be more rapidly determined in the clinical evaluation. The eyeballing method has been largely applied in echocardiography [ 20 , 21 ]. In the present study, we measured the variability and waveform of peripheral arterial blood flow velocity in patients with traumatic shock who were undergoing mechanical ventilation.…”

A machine learning algorithm supports ultrasound-naïve novices in the acquisition of diagnostic echocardiography loops and provides accurate estimation of LVEF

“…When performed by humans, echocardiography and its measurements are subjective and greatly influenced by the level of expertise [ 5 , 10 ]. Since its first description there have been concerns about the reproducibility of LVEF due to significant intra-observer, inter-observer, and inter-institutional variability of measurements [ 11 – 13 ].…”

Improvement in nutritional status – a determinant of successful transcatheter tricuspid valve repair?

“…Standardization of TR grading is essential, especially for comparability of TTVR success 13 . Available semiquantitative two‐dimensional parameters, as well as gradation of right ventricular size and function via TTE all have significant limitations 14 . The routine application of three‐dimensional echocardiography might be the missing link and should be considered in these patients 15 …”