DEI, University of Bologna, Cesena, Italy.
Romagnolo Scientific Institute for Cancer Research and Treatment, Meldola, Italy.
J Am Soc Echocardiogr. 2017 Nov;30(11):1103-1110. doi: 10.1016/j.echo.2017.06.025. Epub 2017 Aug 16.
Cardiotoxicity is a well-known adverse effect of various chemotherapeutic agents that can be monitored by echocardiography. A decrease in left ventricular ejection fraction (LVEF) triggers consideration for therapy modification or interruption. The aim of this study was to evaluate how variability in LVEF estimates computed using three-dimensional echocardiography could influence cardiotoxicity onset detection.
One hundred eighty one patients with breast cancer treated with anthracycline and trastuzumab were analyzed. LVEF was computed using two commercial software packages. In a subgroup of 40 patients, three-dimensional echocardiographic data were reanalyzed to assess intra- and interobserver variability by two expert investigators using both packages. Global longitudinal strain (GLS) imaging was evaluated in 64 patients.
End-diastolic volume, end-systolic volume, and LVEF measurements obtained applying the two software packages were in good agreement, with small bias and acceptable limits of agreement. Intra- and interobserver variability was smaller using one of the two software packages. However, for both packages, variability indexes were in the range of affecting LVEF estimates at a level that could lead to an inaccurate assessment of cardiac adverse effects of cancer therapeutic drugs. On the basis of LVEF, 11 of 181 patients (6.1%) had cardiotoxicity at 3-month follow-up. The absolute value of GLS was smaller in 16 of 64 patients (25%) thought to have cardiotoxicity on the basis of GLS results, including six of seven patients who had cardiotoxicity considering LVEF in this subgroup.
Following clinical definition of cardiotoxicity onset, variability in LVEF computation by three-dimensional echocardiography could be a confounding factor for cardiotoxicity diagnosis, and different software packages should not be used interchangeably for LVEF monitoring. GLS confirms its predictive value for subsequent cardiotoxicity.
心脏毒性是各种化疗药物的已知不良反应，可以通过超声心动图进行监测。左心室射血分数（LVEF）的降低会引发治疗方法的改变或中断。本研究旨在评估使用三维超声心动图计算 LVEF 估计值的变异性如何影响心脏毒性的发生检测。
对 181 例接受蒽环类和曲妥珠单抗治疗的乳腺癌患者进行了分析。使用两种商业软件包计算 LVEF。在 40 例患者的亚组中，由两名专家调查员使用两种软件包对三维超声心动图数据进行重新分析，以评估两种软件包的内部和观察者间变异性。对 64 例患者进行了整体纵向应变（GLS）成像评估。
两种软件包测量的舒张末期容积、收缩末期容积和 LVEF 值具有良好的一致性，偏差较小，一致性界限可接受。使用其中一种软件包时，内部和观察者间的变异性较小。然而，对于两种软件包，变异性指标都处于影响 LVEF 估计值的范围内，可能导致对癌症治疗药物心脏不良作用的评估不准确。根据 LVEF，在 3 个月的随访中有 11 例（6.1%）患者出现心脏毒性。在基于 GLS 结果被认为患有心脏毒性的 64 例患者中，有 16 例（25%）患者的 GLS 绝对值较小，包括该亚组中考虑 LVEF 而患有心脏毒性的 7 例患者中的 6 例。
根据心脏毒性发生的临床定义，三维超声心动图计算 LVEF 的变异性可能是心脏毒性诊断的一个混杂因素，不同的软件包不应该互换使用来监测 LVEF。GLS 证实了其对随后心脏毒性的预测价值。
