Variability in echocardiography and MRI for detection of cancer therapy cardiotoxicity
- 1 June 2020
- Vol. 106 (11), 817-823
- https://doi.org/10.1136/heartjnl-2019-316297
Abstract
Objectives To compare variability of echocardiographic and cardiovascular magnetic resonance (CMR) measured left ventricular (LV) function parameters and their relationship to cancer therapeutics-related cardiac dysfunction (CTRCD). Methods We prospectively recruited 60 participants (age: 49.8 +/- 11.6 years), 30 women with human epidermal growth factor receptor 2-positive breast cancer (15 with CTRCD and 15 without CTRCD) and 30 healthy volunteers. Patients were treated with anthracyclines and trastuzumab. Participants underwent three serial CMR (1.5T) and echocardiography studies at similar to 3-month intervals. Cine-CMR for LV ejection fraction (LVEF), myocardial tagging for global longitudinal strain (GLS) and global circumferential strain (GCS), two-dimensional (2D) echocardiography for strain and LVEF and three-dimensional (3D) echocardiography for LVEF measurements were obtained. Temporal, interobserver and intraobserver variability were calculated as the coefficient of variation and as the SE of the measurement (SEM). Minimal detected difference (MDD) was defined as 2xSEM. Results Patients with CTRCD demonstrated larger mean temporal changes in all parameters compared with those without: 2D-LVEF: 4.6% versus 2.8%; 3D-LVEF: 5.2% vs 2.3%; CMR-LVEF: 6.6% versus 2.7%; 2D-GLS: 1.9% versus 0.7%, 2D-GCS: 2.5% versus 2.2%; CMR-GCS: 2.7% versus 1.6%; and CMR-GLS: 2.1% versus 1.4%, with overlap in 95% CI for 2D-LVEF, 2D-GCS, CMR-GLS and CMR-GCS. The respective mean temporal variability/MDD in healthy volunteers were 3.3%/6.5%, 1.8%/3.7%, 2.2%/4.4%, 0.8%/1.5%, 1.9%/3.7%, 1.8%/3.6% and 1.4%/2.8%. Although the mean temporal variability in healthy volunteers was lower than the mean temporal changes in CTRCD, at the individual level, 2D-GLS, 3D-LVEF and CMR-LVEF had the least overlap. 2D-GLS and CMR-LVEF had the lowest interobserver/intraobserver variabilities. Conclusion Temporal changes in 3D-LVEF, 2D-GLS and CMR LVEF in patients with CTRCD had the least overlap with the variability in healthy volunteers; however, 2D-GLS appears to be the most suitable for clinical application in individual patients.Keywords
Funding Information
- Canadian Institutes of Health Research (137132, 142456, 147814)
This publication has 21 references indexed in Scilit:
- Reproducibility of myocardial strain and left ventricular twist measured using complementary spatial modulation of magnetizationJournal of Magnetic Resonance Imaging, 2013
- Reproducibility of Echocardiographic Techniques for Sequential Assessment of Left Ventricular Ejection Fraction and VolumesJournal of the American College of Cardiology, 2013
- Intraobserver Reliability of Two‐Dimensional Ultrasound Derived Strain Imaging in the Assessment of the Left Ventricle, Right Ventricle, and Left Atrium of Healthy Human HeartsEchocardiography, 2012
- Comprehensive Evaluation of Left Ventricular Strain Using Speckle Tracking Echocardiography in Normal Adults: Comparison of Three-Dimensional and Two-Dimensional ApproachesJournal of the American Society of Echocardiography, 2009
- Myocardial Strain Measurement With 2-Dimensional Speckle-Tracking Echocardiography: Definition of Normal RangeJACC: Cardiovascular Imaging, 2009
- Comparison of the reproducibility of quantitative cardiac left ventricular assessments in healthy volunteers using different MRI scanners: A multicenter simulationJournal of Magnetic Resonance Imaging, 2008
- Real‐time imaging of two‐dimensional cardiac strain using a harmonic phase magnetic resonance imaging (HARP‐MRI) pulse sequenceMagnetic Resonance in Medicine, 2003
- Breath-hold FLASH and FISP Cardiovascular MR Imaging: Left Ventricular Volume Differences and ReproducibilityRadiology, 2002
- Cardiac Dysfunction in the Trastuzumab Clinical Trials ExperienceJournal of Clinical Oncology, 2002
- Accuracy and reproducibility of biplane two-dimensional echocardiographic measurements of left ventricular dimensions and functionEuropean Heart Journal, 1997