Focused cardiac ultrasound conducted by neurologists in patients with stroke: A validation study
Year: 2025
Type: article
Study design: Observational Study
Abstract: 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%, p = 0.834), LV dilation (2.8% vs 2.3%, p = 0.766), VC collapsibility (7.2% vs 9.1%, p = 0.501), Right Ventricle dysfunction (0.9% vs 0.9%, p = 0.999), and pericardial effusion (0.5% vs 1.9%, p = 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.
Source: European Stroke Journal
Authors: Jorge Pagola, Piergiorgio Lochner, Radim Licenik, Giulio Maria Fiore, Felipe A Montellano, Victor Gonzalez, Valérie Pavlicek, Juan Alvarez-Cienfuegos, Sergio Moral, Roberto Muñoz Arrondo, Alberto Vera, Angel Ruiz, Jesús González Mirelis, Jorge Rodríguez-Pardo, Esther Pérez-David, Juan Manuel García-Sánchez, Lara Ruiz Gómez, Laura Amaya Pascasio, Elvira Carrión Ríos, Tania Rodriguez-Ares, Charigan Abou, María Payá, Laura Guerra, Ana de Arce, Ainhoa Benegas Arostegui, Muhammad Khaled Hasan, Vlatka Reskovic
Institutions: Vall d'Hebron Hospital Universitari, Universitätsklinikum des Saarlandes, Saarland University, Peterborough City Hospital, Azienda Ospedaliero-Universitaria Careggi, University of Florence, University of Würzburg, Universitätsklinikum Würzburg, Hospital Universitari de Girona Doctor Josep Trueta, Complejo Hospitalario de Navarra, Hospital Universitario Puerta de Hierro Majadahonda, Hospital La Paz Institute for Health Research, Hospital Universitario La Paz, Hospital de Basurto, Complejo Hospitalario Torrecárdenas, Hospital Universitario Lucus Augusti, Hospital General Universitario de Albacete, Complejo Hospitalario Universitario de Albacete, Donostiako Unibertsitate Ospitalea, University Hospital Centre Zagreb
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4411465360