Arq Bras Cardiol: Imagem cardiovasc. 2025; 38(2): e20250022
Assessment of Interrater Reliability in Point-of-Care Ultrasound for Assessing Congestion in Cardiovascular Intensive Care
DOI: 10.36660/abcimg.20250022i
This Original Article is referred by the Short Editorial "The Use of POCUS in Daily Practice: Are We Really Ready to Use it Efficiently?".
Abstract
Background:
The assessment of congestion is critical for managing patients with cardiovascular conditions, including heart failure (HF). Traditional methods often lack sensitivity, whereas point-of-care ultrasound (POCUS) provides an objective bedside alternative.
Objective:
To evaluate the interrater reliability (IRR) of key POCUS variables used to assess hemodynamic, pulmonary, and venous congestion.
Methods:
This single-center, prospective study was conducted from January to June 2023 in a cardiovascular intensive care unit (CICU) in Brazil. Adult patients underwent standardized POCUS examinations. Three trained investigators independently assessed lung ultrasound (LUS) (B-lines), left ventricular filling pressures (LVFP) (E/A and E/e′ ratios), inferior vena cava (IVC) measurements, hepatic and portal vein Doppler flow, and modified Venous Excess Ultrasound (mVExUS) Score. IRR was analyzed using intraclass correlation coefficient (ICC).
Results:
A total of 23 patients were included, with a median age of 65 years, each undergoing three independent POCUS examinations (69 total assessments). LUS and IVC measurements showed excellent IRR (ICC 0.903). Hepatic and portal vein flows demonstrated good IRR (ICCs 0.808 and 0.796, respectively). mVExUS grading achieved the highest IRR (ICC 0.957). The E wave showed excellent IRR (ICC 0.934), while the A wave and e′ velocity had lower IRRs (0.512 and 0.399, respectively). E/e′ and E/A ratios demonstrated moderate-to-good IRR (ICCs 0.662 and 0.852, respectively). The median exam duration was 10 minutes.
Conclusion:
POCUS variables demonstrated high reproducibility, particularly for LUS and mVExUS. The reproducibility of LUS and mVExUS was higher than that of LVFP parameters, suggesting they may be more reliable than traditional measures such as E/e′. These findings support the use of POCUS for standardized assessment of congestion. Further studies are needed to validate its prognostic value.
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