A Scoping Review of Validated Echocardiographic Methods for Grading Right Ventricular Dysfunction: Proposal for an Evidence-Based Multiparametric Framework.

Abstract

Assessing the severity of right ventricular (RV) dysfunction using echocardiography (echo) remains subjective, in part because current guidelines do not recommend how to synthesize various echo parameters to form a global assessment of RV dysfunction. To address this unmet need, this scoping review aimed (1) to identify all multiparametric RV dysfunction scoring systems that use routine echo parameters and (2) to synthesize these models with 2025 guidelines to create a multiparametric framework for RV dysfunction assessment. MEDLINE, EMBASE, and Web of Science databases were searched for studies in adult patients that propose and validate a multiparametric scoring system for grading RV dysfunction. All studies underwent independent review during abstract and full-text screening. Screening of 2,229 initial citations yielded 10 observational studies consisting of diverse cohorts, including, but not limited to, patients with heart failure, undergoing cardiac surgery, and admitted to the intensive care unit. Six validated echo parameters were identified: RV dilation, RV systolic dysfunction (represented by tricuspid annular plane systolic excursion, S', or fractional area change), tricuspid regurgitation, elevated right atrial pressure, RV-pulmonary artery uncoupling (ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure), and paradoxical interventricular septal motion. The studies demonstrated that multiparametric RV dysfunction scores had greater clinical prognostic value than did any individual RV echo parameter alone. Our proposed simple framework for assessing RV dysfunction enables clinicians to use routinely obtained echo data to identify high-risk or subtle RV phenotypes and to guide clinical decision-making in a variety of perioperative, intensive, and emergency care settings.