Agreement Between Standard and Right Ventricular‐Focused Apical Four‐Chamber Views for Right Ventricular Longitudinal Functional Indices: A Within‐Participant Agreement Study
Fei‐Yi Sun, Ti Zhao, Jia‐Qi Shen, Xiao‐Fang PanABSTRACT
PURPOSE
To determine whether right ventricular (RV) longitudinal functional indices measured from standard and RV‐focused apical four‐chamber (A4C) views are interchangeable at the individual level.
METHODS
We conducted a secondary cross‐sectional agreement analysis of anonymized echocardiographic data acquired in Dalian, China, from January 2021–January 2022. The primary analysis included 115 of 120 screened adults after prespecified eligibility and audit‐stage exclusions; sensitivity analyses retained all 120. Paired measurements comprised tricuspid annular plane systolic excursion (TAPSE), lateral tricuspid annular S′, e′, and a′ velocities, and tissue motion annular displacement (TMAD)‐derived indices. Observer reproducibility was evaluated in 30 cases.
RESULTS
TAPSE was similar between standard and RV‐focused views (22.4 ± 3.6 vs 22.4 ± 3.2 mm; mean difference, −0.09 mm; p = 0.805), and other group‐level differences were small. Individual agreement was limited: intraclass correlation coefficients (ICCs) were 0.40 for TAPSE, 0.45–0.65 for tissue Doppler velocities, and 0.39–0.68 for TMAD indices. Sensitivity‐analysis ICCs remained poor to moderate (0.21–0.65). Intraobserver and interobserver ICCs in the 30‐case subset were 0.97–1.00 and 0.94–0.99, respectively.
CONCLUSION
Standard and RV‐focused A4C views produced similar group means but only poor‐to‐moderate individual agreement. The acquisition view should be kept consistent and documented in serial reports and research datasets.