Filipiak-Strzecka Dominika, Kasprzak Jarosław D, Lipiec Piotr
Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Kniaziewicza 1/5, 91-347 Lodz, Poland.
Diagnostics (Basel). 2023 Feb 14;13(4):724. doi: 10.3390/diagnostics13040724.
The emergence of the COVID-19 pandemic caused a significant shortage of medical personnel and the prioritization of life-saving procedures on internal medicine and cardiology wards. Thus, the cost- and time-effectiveness of each procedure proved vital. Implementing elements of imaging diagnostics into the physical examination of COVID-19 patients could prove beneficial to the treatment process, providing important clinical data at the moment of admission. Sixty-three patients with positive COVID-19 test results were enrolled into our study and underwent physical examination expanded with a handheld ultrasound device (HUD)-performed bedside assessment included: right ventricle measurement, visual and automated LVEF assessment, four-point compression ultrasound test (CUS) of lower extremities and lung ultrasound. Routine testing consisting of computed-tomography chest scanning, CT-pulmonary angiogram and full echocardiography performed on a high-end stationary device was completed in the following 24 h. Lung abnormalities characteristic for COVID-19 were detected in CT in 53 (84%) patients. The sensitivity and specificity of bedside HUD examination for detecting lung pathologies was 0.92 and 0.90, respectively. Increased number of B-lines had a sensitivity of 0.81, specificity 0.83 for the ground glass symptom in CT examination (AUC 0.82; < 0.0001); pleural thickening sensitivity 0.95, specificity 0.88 (AUC 0.91, < 0.0001); lung consolidations sensitivity 0.71, specificity 0.86 (AUC 0.79, < 0.0001). In 20 patients (32%), pulmonary embolism was confirmed. RV was dilated in HUD examination in 27 patients (43%), CUS was positive in two patients. During HUD examination, software-derived LV function analysis failed to measure LVEF in 29 (46%) cases. HUD proved its potential as the first-line modality for the collection of heart-lung-vein imaging information among patients with severe COVID-19. HUD-derived diagnosis was especially effective for the initial assessment of lung involvement. Expectedly, in this group of patients with high prevalence of severe pneumonia, HUD-diagnosed RV enlargement had moderate predictive value and the option to simultaneously detect lower limb venous thrombosis was clinically attractive. Although most of the LV images were suitable for the visual assessment of LVEF, an AI-enhanced software algorithm failed in almost 50% of the study population.
新型冠状病毒肺炎疫情的出现导致医务人员严重短缺，内科和心脏病病房将挽救生命的程序列为优先事项。因此，每种程序的成本效益和时间效益都至关重要。将影像诊断元素纳入新型冠状病毒肺炎患者的体格检查可能对治疗过程有益，在入院时提供重要的临床数据。63例新型冠状病毒肺炎检测结果呈阳性的患者被纳入我们的研究，并接受了体格检查，体格检查通过手持超声设备（HUD）进行床边评估得以扩展，包括：右心室测量、视觉和自动左心室射血分数评估、下肢四点压迫超声检查（CUS）和肺部超声检查。常规检查包括胸部计算机断层扫描、CT肺动脉造影和在高端固定设备上进行的完整超声心动图检查，在接下来的24小时内完成。53例（84%）患者的CT检查中发现了新型冠状病毒肺炎特有的肺部异常。床边HUD检查检测肺部病变的敏感性和特异性分别为0.92和0.90。B线数量增加对CT检查中磨玻璃样症状的敏感性为0.81，特异性为0.83（曲线下面积0.82；<0.0001）；胸膜增厚敏感性0.95，特异性0.88（曲线下面积0.91，<0.0001）；肺实变敏感性0.71，特异性0.86（曲线下面积0.79，<0.0001）。20例患者（32%）确诊为肺栓塞。HUD检查中27例患者（43%）右心室扩张，2例患者CUS检查呈阳性。在HUD检查期间，软件衍生的左心室功能分析在29例（46%）病例中未能测量左心室射血分数。HUD证明了其作为重症新型冠状病毒肺炎患者心肺静脉成像信息收集的一线检查方法的潜力。HUD衍生的诊断对肺部受累的初始评估特别有效。不出所料，在这组重症肺炎患病率较高的患者中，HUD诊断的右心室扩大具有中等预测价值，同时检测下肢静脉血栓形成的选择在临床上很有吸引力。尽管大多数左心室图像适合于左心室射血分数的视觉评估，但人工智能增强软件算法在近50%的研究人群中失败。
