Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Baker Heart and Diabetes Institute, Melbourne, Australia.
JACC Cardiovasc Imaging. 2021 May;14(5):962-974. doi: 10.1016/j.jcmg.2020.09.039. Epub 2020 Nov 25.
This study sought to compare the prognostic value of cardiovascular magnetic resonance (CMR) and 2-dimensional echocardiography (2DE) derived left ventricular (LV) strain, volumes, and ejection fraction for cancer therapy-related cardiac dysfunction (CTRCD) in women with early stage breast cancer.
There are limited comparative data on the association of CMR and 2DE derived strain, volumes, and LVEF with CTRCD.
A total of 125 prospectively recruited women with HER2+ early stage breast cancer receiving sequential anthracycline/trastuzumab underwent 5 serial CMR and 6 of 2DE studies before and during treatment. CMR LV volumes, left ventricular ejection fraction tagged-CMR, and feature-tracking (FT) derived global systolic longitudinal (GLS) and global circumferential strain (GCS) and 2DE-based LV volumes, function, GLS, and GCS were measured. CTRCD was defined by the cardiac review and evaluation committee criteria.
Twenty-eight percent of patients developed CTRCD by CMR and 22% by 2DE. A 15% relative reduction in 2DE-GLS increased the CTRCD odds by 133% at subsequent follow-up, compared with 47%/50% by tagged-CMR GLS/GCS and 87% by FT-GCS. CMR and 2DE-LVEF and indexed left ventricular end-systolic volume (LVESVi) were also associated with subsequent CTRCD. The prognostic threshold change in CMR-left ventricular ejection fraction and FT strain for subsequent CTRCD was similar to the known minimum-detectable difference for these measures, whereas for tagged-CMR strain it was lower than the minimum-detectable difference; for 2DE, only the prognostic threshold for GLS was greater than the minimum-detectable difference. Of all strain methods, 2DE-GLS provided the highest increase in discriminatory value over baseline clinical risk factors for subsequent CTRCD. The combination of 2DE-left ventricular ejection fraction or LVESVi and strain provided greater increase in the area under the curve for subsequent CTRCD over clinical risk factors than CMR left ventricular ejection fraction or LVESVi and strain (18% to 22% vs. 9% to 14%).
In women with HER2+ early stage breast cancer, changes in CMR and 2DE strain, left ventricular ejection fraction, and LVESVi were prognostic for subsequent CTRCD. When LVEF can be measured precisely by CMR, FT strain may function as an additional confirmatory prognostic measure, but with 2DE, GLS is the optimal prognostic measure. (Evaluation of Myocardial Changes During BReast Adenocarcinoma Therapy to Detect Cardiotoxicity Earlier With MRI [EMBRACE-MRI]; NCT02306538).
本研究旨在比较心血管磁共振（CMR）和二维超声心动图（2DE）衍生的左心室（LV）应变、容量和射血分数在接受曲妥珠单抗序贯蒽环类药物治疗的早期乳腺癌女性中的预测价值，以评估与癌症治疗相关的心脏功能障碍（CTRCD）。
关于 CMR 和 2DE 衍生的应变、容量和 LVEF 与 CTRCD 的关联，目前仅有有限的比较数据。
共前瞻性招募了 125 例 HER2+早期乳腺癌女性，她们接受曲妥珠单抗序贯蒽环类药物治疗，并在治疗前和治疗期间进行了 5 次连续 CMR 和 6 次 2DE 研究。测量了 CMR 的 LV 容量、左心室射血分数标记-CMR、特征追踪（FT）衍生的整体纵向应变（GLS）和整体周向应变（GCS），以及 2DE 基于的 LV 容量、功能、GLS 和 GCS。根据心脏审查和评估委员会标准定义 CTRCD。
28%的患者通过 CMR 和 22%的患者通过 2DE 诊断为 CTRCD。与标记-CMR GLS/GCS 的 47%/50%和 FT-GCS 的 87%相比，2DE-GLS 相对减少 15%会使随后的 CTRCD 风险增加 133%。CMR 和 2DE-LVEF 和左心室收缩末期指数（LVESVi）也与随后的 CTRCD 相关。CMR 左心室射血分数和 FT 应变用于预测随后发生 CTRCD 的预测阈值变化与这些测量方法的已知最小可检测差异相似，而标记-CMR 应变的预测阈值则低于最小可检测差异；对于 2DE，只有 GLS 的预测阈值大于最小可检测差异。在所有应变方法中，2DE-GLS 为随后发生的 CTRCD 提供了高于基线临床危险因素的最高鉴别价值增加。与 CMR 左心室射血分数或 LVESVi 和应变相比，2DE 左心室射血分数或 LVESVi 和应变联合应变（18%至 22%比 9%至 14%）为随后发生的 CTRCD 提供了更大的曲线下面积增加。
在 HER2+早期乳腺癌女性中，CMR 和 2DE 应变、左心室射血分数和 LVESVi 的变化与随后发生的 CTRCD 相关。当 CMR 可以精确测量 LVEF 时，FT 应变可能作为额外的确认性预后指标，但在 2DE 中，GLS 是最佳的预后指标。（乳腺癌腺癌治疗期间心肌变化的评估[EMBRACE-MRI]；NCT02306538）。
