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. 2025 Jun 19:23969873251345374.
doi: 10.1177/23969873251345374. Online ahead of print.

Focused cardiac ultrasound conducted by neurologists in patients with stroke: A validation study

Jorge Pagola  1 , Piergiorgio Lochner  2 , Radim Licenik  3 , Giulio Maria Fiore  1   4   5 , Felipe A Montellano  6   7 , Victor Gonzalez  8 , Valérie Pavlicek  2 , Juan Alvarez-Cienfuegos  9 , Sergio Moral  10 , Roberto Muñoz Arrondo  11 , Alberto Vera  12 , Angel Ruiz  13 , Jesús González Mirelis  14 , Jorge Rodríguez-Pardo  15 , Esther Pérez-David  16 , Juan Manuel García-Sánchez  17 , Lara Ruiz Gómez  18 , Laura Amaya Pascasio  19 , Elvira Carrión Ríos  20 , Tania Rodriguez-Ares  21 , Charigan Abou  22 , María Payá  23 , Laura Guerra  24 , Ana de Arce  25 , Ainhoa Benegas Arostegui  26 , Muhammad Khaled Hasan  3 , Vlatka Reskovic  27
Affiliations

Focused cardiac ultrasound conducted by neurologists in patients with stroke: A validation study

Jorge Pagola et al. Eur Stroke J. .

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.

Keywords: Echocardiography; FoCUS; akinesia; left ventricle dysfunction; sources of stroke; stroke.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical abstract
Graphical abstract
Figure 1.
Figure 1.
Percentage of patients according to each question on the FoCUS validation questionnaire. LV dysfunct: left ventricle dysfunction; LV dilat: left ventricle dilation; VC collapsa: vena cava collapsibility; RV dysfunct: right ventricle dysfunction; Pericard effus: pericardial effusion.
Figure 2.
Figure 2.
STARD diagram of FoCUS agreement between neurologists and cardiologists for left ventricle (LV) dysfunction evaluation. In patients with optimal thoracic window the agreement was substantial (Cohen Kappa 0.640, 95% CI [0.424–0.855]).
Figure 3.
Figure 3.
STARD diagram of FoCUS agreement between neurologists and cardiologists to evaluate LV dilation. In patients with optimal thoracic window the agreement was substantial (Cohen Kappa 0.589, 95% CI [0.236–0.941]).
Figure 4.
Figure 4.
STARD diagram of FoCUS agreement between neurologists and cardiologists for VC collapsibility evaluation. In patients with optimal thoracic window the agreement was slight (Cohen Kappa 0.226, 95% CI [−0.02 to 0.480]).
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