神经科医生对中风患者进行的心脏聚焦超声检查：一项验证性研究。
Focused cardiac ultrasound conducted by neurologists in patients with stroke: A validation study.
作者信息
Pagola Jorge, Lochner Piergiorgio, Licenik Radim, Fiore Giulio Maria, Montellano Felipe A, Gonzalez Victor, Pavlicek Valérie, Alvarez-Cienfuegos Juan, Moral Sergio, Muñoz Arrondo Roberto, Vera Alberto, Ruiz Angel, González Mirelis Jesús, Rodríguez-Pardo Jorge, Pérez-David Esther, García-Sánchez Juan Manuel, Ruiz Gómez Lara, Amaya Pascasio Laura, Carrión Ríos Elvira, Rodriguez-Ares Tania, Abou Charigan, Payá María, Guerra Laura, de Arce Ana, Benegas Arostegui Ainhoa, Hasan Muhammad Khaled, Reskovic Vlatka
机构信息
Vall d'Hebron University Hospital, Stroke Unit, Neurology Department, Barcelona, Spain.
Faculty of Medicine, Saarland University Hospital and Saarland University, Homburg, Saarland, Germany.
出版信息
Eur Stroke J. 2025 Jun 19:23969873251345374. doi: 10.1177/23969873251345374.
INTRODUCTION
Focused cardiac ultrasound (FoCUS) has a high diagnostic yield and a rapid theoretical learning curve. FoCUS can be applied in stroke assessments performed by stroke neurologists when a cardioembolic stroke is suspected.
PATIENTS AND METHODS
An international multicenter, prospective validation study was conducted to assess neurologists' ability to perform FoCUS. The FoCUS examination was defined as a simplified 2D transthoracic echocardiography. Neurologists and cardiologists performed the FoCUS independently and blinded. A twenty-question test evaluated neurologists' ability to recognize sources of cardioembolic stroke from recorded FoCUS studies.
RESULTS
A total of 432 paired studies involving 216 patients were conducted across 11 centers. No significant differences were found between neurologists and cardiologists in detecting: Left Ventricle (LV) dysfunction (7.4% vs 7.9%, = 0.834), LV dilation (2.8% vs 2.3%, = 0.766), VC collapsibility (7.2% vs 9.1%, = 0.501), Right Ventricle dysfunction (0.9% vs 0.9%, = 0.999), and pericardial effusion (0.5% vs 1.9%, = 0.212). Cohen Kappa showed substantial agreement for LV dysfunction (0.640), moderate for LV dilation (0.589), and fair for VC collapsibility (0.226). Neurologists demonstrated 93.82% sensitivity and 92.92% specificity for detecting embolic sources. Success rate for LV akinesia was 88% (16/18), LV dysfunction 83% (15/18), complex aortic plaque 88% (16/18), and mitral stenosis 55% (10/18).
DISCUSSION AND CONCLUSION
Properly trained neurologists can reliably perform FoCUS, particularly for assessing LV function and dilation, with better results in patients with favorable echocardiographic windows. While VC assessment requires further training, neurologists demonstrated high accuracy in identifying cardioembolic sources (over 90% of cases correctly identified). This study supports implementing standardized FoCUS training for neurologists through collaboration with cardiology specialists to enhance stroke diagnostics and management.
引言
聚焦心脏超声（FoCUS）具有较高的诊断率和快速的理论学习曲线。当怀疑为心源性栓塞性卒中时，FoCUS可应用于卒中神经科医生进行的卒中评估。
患者与方法
开展了一项国际多中心前瞻性验证研究，以评估神经科医生进行FoCUS检查的能力。FoCUS检查被定义为一种简化的二维经胸超声心动图检查。神经科医生和心脏科医生独立且在不知情的情况下进行FoCUS检查。一项包含20个问题的测试评估了神经科医生从记录的FoCUS研究中识别心源性栓塞性卒中来源的能力。
结果
在11个中心共进行了432对涉及216名患者的研究。在检测以下方面，神经科医生和心脏科医生之间未发现显著差异：左心室（LV）功能障碍（7.4%对7.9%，P = 0.834）、LV扩张（2.8%对2.3%，P = 0.766）、腔静脉可塌陷性（7.2%对9.1%，P = 0.501）、右心室功能障碍（0.9%对0.9%，P = 0.999）以及心包积液（0.5%对1.9%，P = 0.212）。Cohen Kappa系数显示，对于LV功能障碍，一致性较高（0.640）；对于LV扩张，一致性中等（0.589）；对于腔静脉可塌陷性，一致性一般（0.226）。神经科医生在检测栓塞源方面的敏感性为93.82%，特异性为92.92%。LV运动减弱的成功率为88%（16/18），LV功能障碍为83%（15/18），复杂主动脉斑块为88%（16/18），二尖瓣狭窄为55%（10/18）。
讨论与结论
经过适当培训的神经科医生能够可靠地进行FoCUS检查，尤其是在评估LV功能和扩张方面，对于超声心动图窗条件良好的患者效果更佳。虽然腔静脉评估需要进一步培训，但神经科医生在识别心源性栓塞源方面表现出较高的准确性（超过90%的病例能够正确识别）。本研究支持通过与心脏科专家合作，为神经科医生开展标准化的FoCUS培训，以加强卒中的诊断和管理。
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