ASTEM Research Centre, School of Sport and Exercise Sciences, College of Engineering, Swansea University, United Kingdom.
Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
Physiol Meas. 2021 Nov 2;42(10). doi: 10.1088/1361-6579/ac28e5.
Breast cancer treatment can negatively impact cardiac function in some breast cancer patients. Current methods (MUGA, echocardiography) used in clinical practice to detect abnormal cardiac changes as a result of treatment suffer from important limitations. Use of alternative techniques that would offer safe, inexpensive and non-invasive cardiac function assessment in this population would be highly advantageous. The aim of this study was to examine the agreement between impedance cardiography (ICG) and cardiac magnetic resonance imaging (CMR) in quantifying stroke volume (SV), cardiac output (CO) and end-diastolic volume (EDV) in this population.Sixteen breast cancer patients underwent ICG and CMR assessments at three time-points (before treatment, immediately after chemotherapy, and four months after chemotherapy). Bland-Altman analysis was used to quantify the accuracy and precision of ICG (relative to CMR) in estimating absolute values of SV, CO and EDV. Four methods (concordance rate, polar concordance rate, clinical concordance rate and trend interchangeability rate) were also used to assess ICG performance in tracking changes in these variables.Bland-Altman analysis showed that the accuracy of ICG relative to CMR was -3.1 ml (SV), 0.2 l·min(CO) and -26.0 ml (EDV) and precision was 13.2 ml (SV), 1.1 l·min(CO) and 20.1 ml (EDV), respectively. Trending ability assessment showed that (1) the concordance rate was 87% (SV), 73% (CO) and 73% (EDV), (2) the polar concordance rate was 67% (SV), 53% (CO) and 33% (EDV), (3) the clinical concordance rate was 33% (SV), 40% (CO) and 20% (EDV) and (4) the trend interchangeability rate was 29% (SV), 43% (CO) and 17% (EDV), respectively.Our findings show that, although ICG showed good accuracy for absolute SV and CO measurements and for CO and EDV changes, precision was poor for all variables in terms of both absolute measurements and trend tracking performance. This suggests that ICG cannot be used interchangeably with CMR in breast cancer patients.
乳腺癌治疗会在某些乳腺癌患者中心脏功能产生负面影响。目前在临床实践中使用的 MUGA、超声心动图等方法在检测治疗引起的心脏变化时存在重要的局限性。在该人群中使用能够提供安全、廉价和非侵入性心脏功能评估的替代技术将具有巨大优势。本研究的目的是检验在量化该人群的每搏量(SV)、心输出量(CO)和舒张末期容积(EDV)方面，阻抗心动图(ICG)与心脏磁共振成像(CMR)之间的一致性。16 名乳腺癌患者在三个时间点(治疗前、化疗后即刻和化疗后四个月)进行了 ICG 和 CMR 评估。Bland-Altman 分析用于量化 ICG(相对于 CMR)在估计 SV、CO 和 EDV 的绝对值方面的准确性和精密度。还使用了四种方法(一致性率、极一致性率、临床一致性率和趋势可互换率)来评估 ICG 在跟踪这些变量变化方面的性能。Bland-Altman 分析显示，与 CMR 相比，ICG 的准确性为-3.1ml(SV)、0.2l·min(CO)和-26.0ml(EDV)，精度分别为 13.2ml(SV)、1.1l·min(CO)和 20.1ml(EDV)。趋势评估能力显示，(1)一致性率分别为 87%(SV)、73%(CO)和 73%(EDV)，(2)极一致性率分别为 67%(SV)、53%(CO)和 33%(EDV)，(3)临床一致性率分别为 33%(SV)、40%(CO)和 20%(EDV)，(4)趋势可互换率分别为 29%(SV)、43%(CO)和 17%(EDV)。我们的研究结果表明，尽管 ICG 对 SV 和 CO 的绝对值测量以及 CO 和 EDV 的变化具有良好的准确性，但就绝对值测量和趋势跟踪性能而言，所有变量的精度均较差。这表明在乳腺癌患者中，ICG 不能与 CMR 互换使用。
