Cardio Oncology
Muhummad Sohaib Nazir, PhD
NIHR Clinical Lecturer in Cardiology
King's College London, United Kingdom
Muhummad Sohaib Nazir, PhD
NIHR Clinical Lecturer in Cardiology
King's College London, United Kingdom
Joseph Okafor
Clinical Research Fellow
King's College London, United Kingdom
Theodore Murphy, MD
Consultant Cardiologist
Royal Brompton Hospital, United Kingdom
Maria Sol Andres, MD
Clinical Research Fellow
Royal Brompton Hospital, United Kingdom
Tharshini Ramalingham
GP with Specialist interest in Cardio-Oncology
Royal Brompton Hospital, United Kingdom
Stuart Rosen, PhD
Professor of Cardiology
Royal Brompton Hospital, United Kingdom
Amedeo Chiribiri, MD PhD FHEA FSCMR
Professor of Cardiovascular Imaging; Consultant Cardiologist
King's College London
London, England, United Kingdom
Sven Plein, MD, PhD
Professor
University of Leeds
Leeds, England, United Kingdom
Sanjay Prasad, MD, PhD, FSCMR
Professor
Royal Brompton Hospital and Imperial College London, London, England, United Kingdom
Raad Mohiaddin, MD, PhD
Professor/Radiologist
Royal Brompton Hospital, Imaging Centre, Guy’s and St Thomas’ NHS Foundation Trust, United Kingdom and National Heart and Lung Institute, Imperial College London, London, United Kingdom
London, England, United Kingdom
Dudley Pennell, FSCMR
Professor
Guy's and St Thomas' NHS Foundation Trust
London, England, United Kingdom
John Baksi, MBBS PhD
Consultant Cardiologist
Royal Brompton Hospital, England, United Kingdom
Rajdeep Khattar, MD, PhD
Consultant Cardiologist
Royal Brompton Hospital, United Kingdom
Alexander Lyon
Senior Clinical Lecturer and Honorary Consultant Cardiologist
Royal Brompton Hospital, United Kingdom
Left ventricular ejection fraction (LVEF) is widely used for assessment of cancer therapy-related cardiac dysfunction (CTRCD) in patients who receive cardiotoxic cancer therapies. Cardiovascular Magnetic Resonance (CMR) is the reference standard for LVEF assessment, but echocardiography is the most widely used imaging modality. This study sought to compare LVEF measured by echocardiography and CMR in cancer patients with suspected cardiotoxicity and assess potential impact on downstream clinical decision-making.
Methods:
In this prospective single-center observational study, 745 patients who underwent same day imaging with echocardiography and CMR were recruited. Cases with suboptimal image quality and those in whom 2D Biplane Simpson’s method could not be performed were excluded. A sub-set of 74 patients also had 3D echocardiography-derived LVEF. Agreement of LVEF was determined by Bland-Altman analysis.
Results:
Mean age of patients was 60±5 years, of whom 62% were female. LVEF measured by 2D echocardiography was significantly lower compared to CMR, (median 60% [interquartile range 54-65%]) vs 63% [interquartile range 56-69%], p< 0.001). Using Bland-Altman analysis, the mean bias was -3.7±7.6% (95% limits of agreement [LOA] -18.5 to 11.1%) of 2D echocardiography versus CMR derived LVEF (Figure 1). Among 74 patients in whom CMR, 3D echocardiography and 2D echocardiography were performed, LVEF was 60.0±10.4%, 58.4±9.4% and 57.2±8.9%, respectively (p=0.0006). There was better agreement with 3D echocardiography and CMR derived LVEF (mean bias of -1.6±6.3 [95% LOA -13.9 to 10.7%]) compared to 2D echocardiography and CMR derived LVEF (mean bias of -2.8±6.3 [95% LOA-15.2 to 9.6%]), (p=0.02). (Figure 2).
Conclusion:
2D echocardiography and CMR derived LVEF measurements are not interchangeable. 2D echocardiography has variations of up to ±15% compared to CMR. 3D echocardiography has better agreement with CMR derived LVEF. This study supports recent guidelines which recommend the use of 3D echocardiography in cardio-oncology patients and suspected CTRCD.