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

Background: 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.

Methods: Fifty-seven pediatric cancer survivors, 10 to 42 years of age, with cumulative anthracycline doses ≥ 200 mg/m(2), were studied with transthoracic echocardiography and CMR 2.4 to 26.9 years after chemotherapy.

Results: Three-dimensional echocardiography had the highest sensitivity in identifying subjects with CMR-derived ejection fractions < 55%. Subjects with end-systolic volume index values > 29 mL/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 <10 cm/sec at the interventricular septum also identified subjects with lower average peak midwall longitudinal strain and peak midwall circumferential strain magnitudes by CMR.

Conclusions: Three-dimensional echocardiographic ejection fraction < 55%, end-systolic volume index > 29 mL/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 <10 cm/sec by Doppler tissue imaging are the most sensitive transthoracic echocardiographic parameters to identify subjects with subclinical myocardial dysfunction by CMR.