O'Driscoll Patrick, Gent David, Corbett Liam, Stables Rod, Dobson Rebecca
Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.
Liverpool Centre for Cardiovascular Science, Liverpool, UK.
Echo Res Pract. 2024 Dec 16;11(1):27. doi: 10.1186/s44156-024-00063-y.
Following the publication of international cardio-oncology (CO) imaging guidelines, standard echocardiographic monitoring parameters of left ventricular systolic function have been endorsed. Recommendations highlight that either two-dimensional (2D) or three-dimensional (3D) left ventricular ejection fraction (LVEF), alongside global longitudinal strain (GLS) should be routinely performed for surveillance of patients at risk of cancer therapy-related cardiac dysfunction (CTRCD). We studied the feasibility of 3D-LVEF, 2D-GLS and 2D-LVEF in a dedicated CO service.
This was a single-centre prospective analysis of consecutive all-comer patients (n = 105) referred to an NHS CO clinic. Using a dedicated Philips EPIQ CVx v7.0, with X5-1 3D-transducer and 3DQA software, we sought to acquire and analyse 2D- and 3D-LVEF and 2D-GLS, adhering to the British Society of Echocardiography (BSE) and British Cardio-Oncology Society (BCOS) transthoracic echocardiography protocol.
A total of 105 patients were enrolled in the study; 5 were excluded due to carcinoid heart disease (n = 5). Calculation of 3D-LVEF was achieved in 40% (n = 40), 2D-GLS in 73% (n = 73), and 2D-LVEF in 81% (n = 81). LV quantification was not possible in 19% (n = 19) due to poor myocardial border definition. Strong correlation existed between 2D-LVEF and 3D-LVEF (r = 0.94, p < 0.0001). Bland-Altman plot demonstrated no statistical differences in that the mean deviation between 2D-LVEF and 3D-LVEF were consistent throughout a range of LVEF values. The most persistent obstacle to 3D-LVEF acquisition was insufficient myocardial border tracking (n = 30, 50%).
This study demonstrates the high feasibility of 2D-GLS and 2D-LVEF, even in those with challenging echocardiographic windows. The lower feasibility of 3D-LVEF limits its real-world clinical application, even though only a small difference in agreement with 2D-LVEF calculation was found when successfully performed.
随着国际心脏肿瘤学（CO）成像指南的发布，左心室收缩功能的标准超声心动图监测参数已得到认可。建议强调，二维（2D）或三维（3D）左心室射血分数（LVEF）以及整体纵向应变（GLS）应常规用于监测有癌症治疗相关心脏功能障碍（CTRCD）风险的患者。我们研究了在专门的CO服务中进行3D-LVEF、2D-GLS和2D-LVEF检查的可行性。
这是一项对转诊至英国国家医疗服务体系（NHS）CO诊所的所有连续患者（n = 105）进行的单中心前瞻性分析。使用配备X5-1 3D换能器和3DQA软件的专用飞利浦EPIQ CVx v7.0，我们试图获取并分析2D-和3D-LVEF以及2D-GLS，遵循英国超声心动图学会（BSE）和英国心脏肿瘤学会（BCOS）的经胸超声心动图检查方案。
共有105名患者纳入研究；5名因类癌性心脏病（n = 5）被排除。3D-LVEF计算成功率为40%（n = 40），2D-GLS为73%（n = 73），2D-LVEF为81%（n = 81）。由于心肌边界定义不佳，19%（n = 19）的患者无法进行左心室定量分析。2D-LVEF与3D-LVEF之间存在强相关性（r = 0.94，p < 0.0001）。布兰德-奥特曼图显示无统计学差异，因为在一系列LVEF值范围内，2D-LVEF与3D-LVEF之间的平均偏差是一致的。获取3D-LVEF最持久的障碍是心肌边界跟踪不足（n = 30，50%）。
本研究表明，即使对于超声心动图窗口具有挑战性的患者，2D-GLS和2D-LVEF也具有很高的可行性。3D-LVEF的可行性较低，限制了其在实际临床中的应用，尽管成功进行时与2D-LVEF计算的一致性仅存在微小差异。
