What question did this study set out to answer?

This research aims to assess the efficacy of ultrafast ultrasound with phrenic stimulation in diagnosing diaphragm dysfunction compared to the gold standard.

June 19, 2026Open Access

First Evaluation of Ultrafast Ultrasound Coupled With Phrenic Stimulation for Noninvasive Diagnosis of Diaphragm Dysfunction

Puntos clave

This research aims to assess the efficacy of ultrafast ultrasound with phrenic stimulation in diagnosing diaphragm dysfunction compared to the gold standard.
Thirty patients assessed for diaphragm dysfunction underwent magnetic stimulation and ultrafast ultrasound.
Associations between ultrasound metrics and Pdi,tw were examined using ridge regression and Bayesian ROC analysis.
Diagnostic performance metrics included sensitivity, specificity, and concordance correlation coefficients.
80% of patients exhibited abnormal Pdi,tw values.
Ultrafast ultrasound descriptors showed high correlation with Pdi,tw (Spearman's ρ for velocity 0.77, acceleration 0.70, jerk 0.67; all p < 0.0001).
Bayesian ROC analysis demonstrated strong diagnostic discrimination with an AUC of 0.91, and model predicted Pdi,tw had 75% sensitivity and 100% specificity.

Resumen

ABSTRACT Background Diaphragm dysfunction is an important and often unrecognized cause of dyspnea. The current gold standard, transdiaphragmatic twitch pressure (Pdi,tw), requires oesophageal and gastric balloon catheters and is infrequently used in routine care. We evaluated whether ultrafast ultrasound descriptors of costal diaphragm during bilateral phrenic magnetic stimulation can provide a noninvasive alternative for assessing diaphragm contractility. Methods Thirty patients (19 men and 11 women) referred for suspected diaphragm dysfunction (median age 57 42–63 years) underwent bilateral anterolateral magnetic stimulation with simultaneous ultrafast ultrasound and oesophageal/gastric pressure recordings. Peak diaphragm tissue velocity, acceleration and jerk were extracted. Associations with Pdi,tw were assessed using ridge regression. Diagnostic performance for detecting abnormal Pdi,tw (< 20 cmH 2 O) was evaluated using Bayesian receiver operating characteristic (ROC) analysis, including posterior mean AUC and 95% credible intervals. Agreement between predicted and measured Pdi,tw was assessed using Lin's concordance correlation coefficient and Passing–Bablok regression. Results Twenty four of 30 patients (80%) had abnormal Pdi,tw. Ultrafast ultrasound descriptors correlated with Pdi,tw (Spearman's ρ : velocity 0.77 95% CI, 0.57–0.89, acceleration 0.70 95% CI, 0.41–0.87, jerk 0.67 95% CI, 0.43–0.85; all p < 0.0001). The multivariable ridge model explained 66% of the variance in Pdi,tw and showed high agreement with measured values (Lin's concordance correlation coefficient = 0.87 95% CI, 0.75–0.93). Bayesian ROC analysis demonstrated strong discrimination of diaphragm dysfunction (AUC = 0.91; 95% credible interval CrI, 0.76–0.98). Using the clinical threshold of 20 cmH 2 O, model‐predicted Pdi,tw yielded a sensitivity of 75% and specificity of 100%. The optimal velocity threshold for discriminating abnormal Pdi,tw was 10.25 mm·ms −1 (95% CrI, 6.12–18.58 mm·ms −1 ). The corresponding thresholds for acceleration and jerk were 408.6 mm·ms −2 (95% CrI, 122.6–952.4) and 3073 mm·ms −3 (95% CrI, 1038.8–11541.4), respectively. Conclusions Ultrafast ultrasound coupled with magnetic phrenic stimulation provides a feasible, noninvasive, nonvolitional assessment of diaphragm contractility. Diaphragm motion descriptors reliably predicted Pdi,tw and enabled accurate identification of diaphragm dysfunction. These findings support further clinical evaluation and warrant larger multicentre validation studies.

Leer artículo completoexternamente

Me gusta

Guardar

Ver artículo completo