Zhang Wanzhu, Azibani Feriel, Libhaber Elena, Nankabirwa Joaniter, Okello Emmy, Kayima James, Ssinabulya Isaac, Sliwa Karen
Department of Medicine and Cardiology, Faculty of Health Science, Cape Heart Institute, University of Cape Town, Cape Town, South Africa.
Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda.
Front Cardiovasc Med. 2022 Nov 18;9:966230. doi: 10.3389/fcvm.2022.966230. eCollection 2022.
Subclinical anthracycline therapy related cardiac dysfunction (ATRCD) can be detected with speckle tracking echocardiographic image (STE), which is not widely available in Uganda. We aimed to investigate the role of the two conventional echocardiographic parameters [mitral annular plane systolic excursion (MAPSE) and mitral annular peak systolic tissue Doppler velocity (S')] on diagnosing subclinical ATRCD.
207 cancer patients who underwent anthracycline based chemotherapy were recruited at baseline and followed up until 6 months after ending anthracycline therapy. Comprehensive echocardiographic data were collected at each visit. Global longitudinal strain (GLS) by STE was used as the gold standard diagnostic test to define the case of subclinical ATRCD. Data of the 200 patients who had no evidence of clinical ATRCD were analyzed. One hundred and seventy-two (86.0%) were female, with a median age of 42 years and 47 (23.5%) patients were diagnosed with subclinical ATRCD at the end of anthracycline therapy by GLS criteria. The area under the curve (AUC), cutoff point, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of reduction of MAPSE (ΔMAPSE) were 0.6736 (95% CI: 0.5885, 0.7587), ≥ 2 mm, 74.5% (95% CI: 59.7%, 86.1%), 54.9% (95% CI: 46.7%, 63.0%), 33.7% (95% CI: 24.7%, 43.6%), and 87.5% (95% CI: 79.2%, 93.4%). The AUC, cutoff point, sensitivity, specificity, PPV, and NPV of reduction of S' (ΔS') were 0.6018 (95% CI: 0.5084, 0.6953), ≥ 0.5 cm/s, 61.7% (95% CI: 46.4%, 75.5%), 52.7% (95% CI: 44.4%, 60.9%), 29.0% (95% CI: 20.4%, 38.9%), and 76.1% (95% CI: 72.4%, 88.6%). When ΔMAPSE and ΔS' are used as parallel test, the net sensitivity and specificity is 89.4% and 28.8%, respectively, the net PPV and NPV is 27.8% and 90.0%, respectively.
The ΔMAPSE and ΔS' showed fairly good accuracy, sensitivity and NPV to detect subclinical ATRCD in Ugandan cancer patients. These conventional echocardiographic parameters may serve as screening tools for detecting subclinical ATRCD in resource limited settings.
亚临床蒽环类药物治疗相关心脏功能障碍（ATRCD）可通过斑点追踪超声心动图图像（STE）检测到，但在乌干达尚未广泛应用。我们旨在研究两个传统超声心动图参数[二尖瓣环平面收缩期位移（MAPSE）和二尖瓣环收缩期峰值组织多普勒速度（S'）]在诊断亚临床ATRCD中的作用。
招募了207例接受蒽环类药物化疗的癌症患者，在基线时进行评估，并随访至蒽环类药物治疗结束后6个月。每次随访时收集全面的超声心动图数据。以STE测量的整体纵向应变（GLS）作为诊断亚临床ATRCD的金标准。对200例无临床ATRCD证据的患者数据进行分析。172例（86.0%）为女性，中位年龄42岁，47例（23.5%）患者在蒽环类药物治疗结束时根据GLS标准被诊断为亚临床ATRCD。MAPSE降低值（ΔMAPSE）的曲线下面积（AUC）、截断点、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为0.6736（95%CI：0.5885，0.7587）、≥2mm、74.5%（95%CI：59.7%，86.1%）、54.9%（95%CI：46.7%，63.0%）、33.7%（95%CI：24.7%，43.6%）和87.5%（95%CI：79.2%，93.4%）。S'降低值（ΔS'）的AUC、截断点、敏感性、特异性、PPV和NPV分别为0.6018（95%CI：0.5084，0.6953）、≥0.5cm/s、61.7%（95%CI：46.4%，75.5%）、52.7%（95%CI：44.4%，60.9%）、29.0%（95%CI：20.4%，38.9%）和76.1%（95%CI：72.4%，88.6%）。当将ΔMAPSE和ΔS'用作平行试验时，净敏感性和特异性分别为89.4%和28.8%，净PPV和NPV分别为27.8%和90.0%。
ΔMAPSE和ΔS'在检测乌干达癌症患者亚临床ATRCD方面显示出相当好的准确性、敏感性和NPV。这些传统超声心动图参数可作为在资源有限环境中检测亚临床ATRCD的筛查工具。
