Variability in echocardiography and MRI for detection of cancer therapy cardiotoxicity

Abstract

ObjectivesTo 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).MethodsWe 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 ~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.ResultsPatients 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.ConclusionTemporal 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.

Head‐to‐head comparison of cardiovascular MR feature tracking cine versus acquisition‐based deformation strain imaging using myocardial tagging and strain encoding

“…Beyond limited agreement within FT‐derived deformation assessment, the current data demonstrate distinct deviations for different approaches applied to evaluate myocardial deformation. Furthermore, as opposed to speckle tracking, which also demonstrates excellent intra‐observer and interobserver variability especially for GLS, 37 and tagging, validity of CMR FT has not been compared with phantom or animal work using the reference standard of sonomicrometry 38 . Despite the limitations of FT intervendor agreements, 16‐18 the use of FT on bSSFP images is not subject to variability caused by different scanners or field strengths 13 .…”

Global Longitudinal Strain Monitoring to Guide Cardioprotective Medications During Anthracycline Treatment

“…The most reliable assessment of LV volumes and ejection fraction is obtainable with CMR, and this has been shown to be effective in predicting outcomes [30]. The variability of CMR-LVEF is similar to echocardiographic 3D-EF or GLS, and less than echocardiographic 2D-EF [31]. CMR-based GLS is feasible, but probably not superior to echo-based GLS.…”

Cardiotoxicity of Epidermal Growth Factor Receptor 2-Targeted Drugs for Breast Cancer

“…Patients with persistent worsening in diastolic function while taking breast cancer chemotherapeutic agents have a small risk of subsequent systolic dysfunction ( Upshaw et al, 2020 ). There are two new prospective studies comparing variability of echocardiography and cardiovascular magnetic resonance (CMR) in detecting cardiac dysfunction associated with cancer chemotherapy, but the results of these studies are inconclusive ( Lambert et al, 2020 ; Houbois et al, 2021 ). Therefore, 2D-GLS appears to be the most suitable for clinical applications in individual patients.…”