Emory University School of Medicine, Atlanta, Georgia, USA.
Children's Medical Center, University of Texas Southwestern, Dallas, Texas, USA.
Echocardiography. 2024 Feb;41(2):e15766. doi: 10.1111/echo.15766.
A previous multicenter study showed that longitudinal changes in standard cardiac functional parameters were associated with the development of cardiomyopathy in childhood cancer survivors (CCS). Evaluation of the relationship between global longitudinal strain (GLS) changes and cardiomyopathy risk was limited, largely due to lack of quality apical 2- and 3-chamber views in addition to 4-chamber view. We sought to determine whether apical 4-chamber longitudinal strain (A4LS) alone can serve as a suitable surrogate for GLS in this population.
A4LS and GLS were measured in echocardiograms with acceptable apical 2-, 3-, and 4-chamber views. Correlation was evaluated using Pearson and Spearman coefficients, and agreement was evaluated with Bland-Altman plots. The ability of A4LS to identify normal and abnormal values compared to GLS as the reference was evaluated.
Among a total of 632 reviewed echocardiograms, we identified 130 echocardiograms from 56 patients with adequate views (38% female; mean age at cancer diagnosis 8.3 years; mean follow-up 9.4 years). Correlation coefficients between A4LS and GLS were .89 (Pearson) and .85 (Spearman), with Bland-Altman plot of GLS-A4LS showing a mean difference of -.71 ± 1.8. Compared with GLS as the gold standard, A4LS had a sensitivity of 86% (95% CI 79%-93%) and specificity of 82% (69%-95%) when using normal range cutoffs and 90% (82%-97%) and 70% (58%-81%) when using ±2 standard deviations.
A4LS performs well when compared with GLS in this population. Given the more recent adoption of apical 2- and 3-chamber views in most pediatric echocardiography laboratories, A4LS is a reasonable stand-alone measurement in retrospective analyses of older study cohorts and echocardiogram biorepositories.
先前的多中心研究表明，标准心脏功能参数的纵向变化与儿童癌症幸存者（CCS）心肌病的发展有关。评估整体纵向应变（GLS）变化与心肌病风险之间的关系受到限制，主要是由于缺乏质量的 apical 2-和 3-腔视图，除了 4-腔视图。我们试图确定在这种人群中，apical 4-腔纵向应变（A4LS）是否可以单独作为 GLS 的合适替代物。
在具有可接受的 apical 2-、3-和 4-腔视图的超声心动图中测量 A4LS 和 GLS。使用 Pearson 和 Spearman 系数评估相关性，并使用 Bland-Altman 图评估一致性。评估 A4LS 与 GLS 相比作为参考标准来识别正常和异常值的能力。
在总共审查的 632 份超声心动图中，我们从 56 名患者的 130 份超声心动图中识别出足够的视图（38%为女性；癌症诊断时的平均年龄为 8.3 岁；平均随访时间为 9.4 年）。A4LS 和 GLS 之间的相关系数分别为.89（Pearson）和.85（Spearman），GLS-A4LS 的 Bland-Altman 图显示平均差异为-.71±1.8。与 GLS 作为金标准相比，当使用正常范围截止值时，A4LS 的灵敏度为 86%（95%CI 79%-93%）和特异性为 82%（69%-95%），当使用±2 个标准差时，灵敏度为 90%（82%-97%）和特异性为 70%（58%-81%）。
在该人群中，A4LS 与 GLS 相比表现良好。鉴于最近在大多数儿科超声心动图实验室中采用了 apical 2-和 3-腔视图，A4LS 是对较旧研究队列和超声心动图生物库的回顾性分析的合理独立测量。
