超声心动图和 MRI 在癌症治疗性心脏毒性检测中的变异性。
Variability in echocardiography and MRI for detection of cancer therapy cardiotoxicity.
机构信息
Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Rogers Computational Program, Peter Munk Cardiac Center, Cardiology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
出版信息
Heart. 2020 Jun;106(11):817-823. doi: 10.1136/heartjnl-2019-316297. Epub 2020 Feb 25.
OBJECTIVES
To 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).
METHODS
We 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.
RESULTS
Patients 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.
CONCLUSION
Temporal 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.
目的
比较超声心动图和心血管磁共振（CMR）测量左心室（LV）功能参数的变异性及其与癌症治疗相关心脏功能障碍（CTRCD）的关系。
方法
我们前瞻性招募了 60 名参与者（年龄：49.8±11.6 岁），其中 30 名为人表皮生长因子受体 2 阳性乳腺癌患者（15 名有 CTRCD，15 名无 CTRCD），30 名健康志愿者。患者接受蒽环类药物和曲妥珠单抗治疗。参与者在大约 3 个月的间隔内进行了 3 次连续的 CMR（1.5T）和超声心动图研究。电影 CMR 用于测量 LV 射血分数（LVEF），心肌标记用于测量整体纵向应变（GLS）和整体周向应变（GCS），二维（2D）超声心动图用于测量应变和 LVEF，三维（3D）超声心动图用于测量 LVEF。计算了时间、观察者间和观察者内的变异性，作为变异系数和测量的标准误差（SEM）。最小检测差异（MDD）定义为 2xSEM。
结果
与无 CTRCD 的患者相比，有 CTRCD 的患者的所有参数的平均时间变化都更大：2D-LVEF：4.6%比 2.8%；3D-LVEF：5.2%比 2.3%；CMR-LVEF：6.6%比 2.7%；2D-GLS：1.9%比 0.7%，2D-GCS：2.5%比 2.2%；CMR-GCS：2.7%比 1.6%；CMR-GLS：2.1%比 1.4%，2D-LVEF、2D-GCS、CMR-GLS 和 CMR-GCS 的 95%CI 有重叠。健康志愿者的相应平均时间变异性/MDD 分别为 3.3%/6.5%、1.8%/3.7%、2.2%/4.4%、0.8%/1.5%、1.9%/3.7%、1.8%/3.6%和 1.4%/2.8%。尽管健康志愿者的平均时间变异性低于 CTRCD 的平均时间变化，但在个体水平上，2D-GLS、3D-LVEF 和 CMR-LVEF 的重叠最少。2D-GLS 和 CMR-LVEF 的观察者间/观察者内变异性最低。
结论
与健康志愿者的变异性相比，有 CTRCD 的患者的 3D-LVEF、2D-GLS 和 CMR LVEF 的时间变化重叠最小；然而，2D-GLS 似乎最适合于个体患者的临床应用。
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