Feasibility of Echocardiographic Techniques to Detect Subclinical Cancer Therapeutics–Related Cardiac Dysfunction among High-Dose Patients When Compared with Cardiac Magnetic Resonance Imaging

Abstract

Cardiac magnetic resonance imaging (CMR) is the gold standard for the quantification of global and regional myocardial function and can detect subclinical myocardial dysfunction in anthracycline-induced cardiomyopathy. The aim of this study was to ascertain reliable echocardiographic parameters that can be used for the early identification of cancer therapeutics-related cardiac dysfunction, compared with CMR. Fifty-seven pediatric cancer survivors, 10 to 42years of age, with cumulative anthracycline doses≥200mg/m(2), were studied with transthoracic echocardiography and CMR 2.4 to 26.9years after chemotherapy. Three-dimensional echocardiography had the highest sensitivity in identifying subjects with CMR-derived ejection fractions<55%. Subjects with end-systolic volume index values>29mL/m(2) were more likely to have CMR-derived ejection fractions<55%. Three-dimensional speckle-tracking echocardiographic peak global longitudinal strain magnitude<-17.5% best identified subjects with abnormal peak midwall longitudinal strain magnitude by CMR. A decrease in early atrial myocardial velocity of <10cm/sec at the interventricular septum also identified subjects with lower average peak midwall longitudinal strain and peak midwall circumferential strain magnitudes by CMR. Three-dimensional echocardiographic ejection fraction<55%, end-systolic volume index>29mL/m(2), three-dimensional speckle-tracking echocardiographic peak global longitudinal strain magnitude<-17.5%, and a decrease in early atrial myocardial velocity at the interventricular septum of <10cm/sec by Doppler tissue imaging are the most sensitive transthoracic echocardiographic parameters to identify subjects with subclinical myocardial dysfunction by CMR.