Measurements of contrast-enhanced echocardiography for left ventricular ejection fraction and left ventricular volume in patients undergoing cancer chemotherapy

Abstract

Objective To discuss the value of contrast-enhanced echocardiography in assessing left heart function by comparing the reproducibility of contrast-enhanced echocardiography and conventional echocardiography for measurements of left ventricular ejection fraction (LVEF) and left ventricular volume in patients undergoing cancer chemotherapy. Methods One hundred and nineteen patients undergoing cancer chemotherapy were divided into satisfactory image group (42 subjects) and unsatisfactory image group (77 subjects) according to the quality of the recorded images. High frame rate two-dimensional and three-dimensional images were recorded from apical long-axis view, four-chamber view and two-chamber view of left ventricle. Contrast-enhanced echocardiography was performed in the unsatisfactory image group. Two equally experienced examiners measured the LVEF and left ventricular volume in all patients by EchoPac software. Results The difference of LVEF measured by Simpson′s biplane method and 3D full-volume echocardiography in satisfactory image group was statistically significant (t=4.224, P<0.01), while there were no significant differences in the measurements of left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV). However, the differences of LVEF and LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography in unsatisfactory image group were both statistically significant (t=8.650, 6.207, both P<0.01). And there was no significant difference in the measurements of LVESV. In satisfactory image group, LVEF, LVEDV and LVESV measured by Simpson′s biplane method or 3D full-volume echocardiography showed no significant differences between two examiners. While in unsatisfactory image group, LVEF and LVEDV measured by Simpson′s biplane method or 3D full-volume echocardiography showed significant differences between two examiners (t=4.286, 3.645, 3.308, 4.189, all P<0.01), except for LVESV. LVEF, LVEDV and LVESV measured by Simpson′s biplane method or 3D full-volume echocardiography showed no significant differences between two examiners in unsatisfactory image group with contrast-enhanced echocardiography. The results of intraclass correlation coefficient (ICC) showed that the reproducibility of LVESV measured by Simpson′s biplane method and 3D full-volume echocardiography was both well in satisfactory image group and unsatisfactory image group without contrast-enhanced echocardiography (ICC=0.901, 0.858, 0.935, 0.920, 0.884, 0.952). The reproducibility of LVEF and LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography was both well in satisfactory image group (ICC=0.946, 0.895, 0.776, 0.815). The reproducibility of LVEF measured by Simpson′s biplane method showed poor results in unsatisfactory image group (ICC=0.625). However, it was improved by performing contrast-enhanced echocardiography (ICC=0.858). The reproducibility of LVEDV measured by Simpson′s biplane method and 3D full-volume echocardiography was poor in unsatisfactory image group (ICC=0.630, 0.712). But it was improved by contrast-enhanced echocardiography in both methods (ICC=0.863, 0.914). Conclusion The reproducibility for measurements of LVEF and left ventricular volume with unsatisfactory images was improved in patients undergoing cancer chemotherapy by using contrast-enhanced echocardiography. Key words: Echocardiography; Contrast media; Drug therapy; Carcinoma; Ventricular function, left