Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures
Abstract Background Right 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...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-03-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13054-019-2375-z |
| _version_ | 1818038222669742080 |
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| author | Sam Orde Michel Slama Konstantin Yastrebov Anthony Mclean Stephen Huang on behalf of the College of Intensive Care Medicine of Australia and New Zealand [CICM] Ultrasound Special Interest Group [USIG] |
| author_facet | Sam Orde Michel Slama Konstantin Yastrebov Anthony Mclean Stephen Huang on behalf of the College of Intensive Care Medicine of Australia and New Zealand [CICM] Ultrasound Special Interest Group [USIG] |
| author_sort | Sam Orde |
| collection | DOAJ |
| description | Abstract Background Right 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. Methods ICU specialists with a qualification in advanced echocardiography reviewed 2D echo clips from critically ill patients on mechanical ventilation with PaO2:FiO2 < 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. Results Fifty-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. Conclusion Subjective (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. |
| first_indexed | 2024-12-10T07:39:19Z |
| format | Article |
| id | doaj.art-eae966a453434f749617c10bcf14abc0 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-10T07:39:19Z |
| publishDate | 2019-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-eae966a453434f749617c10bcf14abc02022-12-22T01:57:21ZengBMCCritical Care1364-85352019-03-012311910.1186/s13054-019-2375-zSubjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measuresSam Orde0Michel Slama1Konstantin Yastrebov2Anthony Mclean3Stephen Huang4on behalf of the College of Intensive Care Medicine of Australia and New Zealand [CICM] Ultrasound Special Interest Group [USIG]Nepean HospitalMedical ICU, Amiens University HospitalSt George HospitalNepean HospitalNepean HospitalAbstract Background Right 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. Methods ICU specialists with a qualification in advanced echocardiography reviewed 2D echo clips from critically ill patients on mechanical ventilation with PaO2:FiO2 < 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. Results Fifty-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. Conclusion Subjective (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.http://link.springer.com/article/10.1186/s13054-019-2375-zRight ventricleSubjective assessmentSpeckle trackingCritically illICU |
| spellingShingle | Sam Orde Michel Slama Konstantin Yastrebov Anthony Mclean Stephen Huang on behalf of the College of Intensive Care Medicine of Australia and New Zealand [CICM] Ultrasound Special Interest Group [USIG] Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures Critical Care Right ventricle Subjective assessment Speckle tracking Critically ill ICU |
| title | Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures |
| title_full | Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures |
| title_fullStr | Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures |
| title_full_unstemmed | Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures |
| title_short | Subjective right ventricle assessment by echo qualified intensive care specialists: assessing agreement with objective measures |
| title_sort | subjective right ventricle assessment by echo qualified intensive care specialists assessing agreement with objective measures |
| topic | Right ventricle Subjective assessment Speckle tracking Critically ill ICU |
| url | http://link.springer.com/article/10.1186/s13054-019-2375-z |
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