Key result
Modified VExUS grading via POCUS achieves ~0.96 interrater reliability for assessing congestion.
Why the study?
Assessing congestion is critical in cardiovascular conditions like heart failure, but traditional methods often lack sensitivity, making point-of-care ultrasound an objective bedside alternative whose interrater reliability required evaluation.
Does point-of-care ultrasound (POCUS) provide reliable interrater assessment of congestion in adult cardiovascular intensive care patients?
Observational (n=23)
Blinded raters
No
Does point-of-care ultrasound (POCUS) provide reliable interrater assessment of congestion in adult cardiovascular intensive care patients?
Point-of-care ultrasound, particularly lung ultrasound and mVExUS, demonstrates high interrater reliability for assessing congestion in cardiovascular intensive care patients, outperforming traditional measures like E/e.
Supports POCUS reliability for congestion assessment in CVICU; leaves open effects on outcomes.
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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Saadi et al. (2025) conducted an observational in Cardiovascular conditions (n=23). Point-of-care ultrasound (POCUS) vs. Interrater comparison was evaluated on Interrater reliability of modified VExUS (mVExUS) grading (ICC 0.957, 95% CI 0.914-0.981, p=<0.001). Point-of-care ultrasound variables demonstrated high interrater reliability for assessing congestion, with modified VExUS grading achieving an intraclass correlation coefficient of 0.957.
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