Department of Pediatrics, University of California, San Diego, California, USA.
Department of Cardiology, Rady Children's Hospital San Diego, San Diego, California, USA.
Echocardiography. 2024 Aug;41(8):e15905. doi: 10.1111/echo.15905.
We sought to assess the feasibility, reproducibility, and accuracy of conventional and newer echocardiographic measures of right ventricular (RV) systolic function in adolescent and young adult childhood cancer survivors treated with anthracyclines.
Echocardiography and cardiac magnetic resonance imaging (CMR) were acquired ≤60 days apart in prospectively recruited survivors and RV functional measures were quantitated by blinded observers. Repeat quantitation was performed in a subset to evaluate reproducibility. For each echocardiographic measure, Spearman correlations with CMR measures were calculated, and values in participants with CMR RV ejection fraction (RVEF) ≥48% and RVEF <48% were compared using two sample Wilcoxon rank-sum tests.
Among 58 participants, mean age was 18.2 years (range 13.1-25.2) and five participants had CMR RVEF <48%. Intra- and inter-observer coefficients of variation were 8.2%-10.1% and 10.5%-12.0% for adjusted automated strain measures, and 5.2%-8.7% and 2.7% for 3D RVEF, respectively. No echocardiographic measures were significantly correlated with CMR RVEF; only tricuspid annular plane systolic excursion was correlated with CMR RV stroke volume (r = .392, p = .003). Participants with RV dysfunction had worse automated global longitudinal strain (-20.3% vs. -23.9%, p = .007) and free wall longitudinal strain (-23.7% vs. -26.7%, p = .09).
Echocardiographic strain and 3D RV function measurements were feasible and reproducible in at-risk childhood cancer survivors. Although not associated with CMR RVEF in this population with predominantly normal RV function, automated strain measurements were more abnormal in participants with RV dysfunction, suggesting potential clinical utility of these measures.
我们旨在评估常规和新型超声心动图测量方法在接受蒽环类药物治疗的青少年和年轻成年期癌症幸存者中的右心室（RV）收缩功能的可行性、可重复性和准确性。
前瞻性招募幸存者在≤60 天内接受超声心动图和心脏磁共振成像（CMR）检查，并由盲法观察者定量 RV 功能测量值。在亚组中进行重复定量以评估可重复性。对于每个超声心动图测量值，计算与 CMR 测量值的 Spearman 相关性，并使用两样本 Wilcoxon 秩和检验比较 CMR RV 射血分数（RVEF）≥48%和 RVEF<48%的参与者的值。
在 58 名参与者中，平均年龄为 18.2 岁（范围 13.1-25.2），5 名参与者的 CMR RVEF<48%。调整后的自动应变测量的内和观察者间变异系数分别为 8.2%-10.1%和 10.5%-12.0%，3D RVEF 分别为 5.2%-8.7%和 2.7%。没有超声心动图测量值与 CMR RVEF 显著相关；只有三尖瓣环平面收缩期位移与 CMR RV 心排量相关（r=0.392，p=0.003）。RV 功能障碍的参与者的自动整体纵向应变（-20.3%比-23.9%，p=0.007）和游离壁纵向应变（-23.7%比-26.7%，p=0.09）更差。
在有风险的儿童癌症幸存者中，超声心动图应变和 3D RV 功能测量是可行和可重复的。尽管在这个 RV 功能主要正常的人群中，这些测量值与 CMR RVEF 无关，但在 RV 功能障碍的参与者中，自动应变测量值更异常，这表明这些测量值具有潜在的临床应用价值。
