Clinical Investigation
3D Echocardiography: Value-Added Applications
New Three-Dimensional Speckle-Tracking Echocardiography Identifies Global Impairment of Left Ventricular Mechanics with a High Sensitivity in Childhood Cancer Survivors

https://doi.org/10.1016/j.echo.2013.04.018Get rights and content

Background

The aim of this case-control study was to assess the usefulness of three-dimensional (3D) speckle-tracking echocardiography in the evaluation of global left ventricular (LV) myocardial performance in adolescent and adult survivors of childhood cancers.

Methods

Fifty-three anthracycline-treated survivors of childhood cancers (mean age, 18.6 ± 5.1 years) and 38 controls were studied. Three-dimensional speckle-tracking echocardiography was performed to assess LV 3D global and segmental strain, time to peak segmental 3D strain, LV torsion, and ejection fraction. LV systolic dyssynchrony index (SDI) was calculated as the percentage of the standard deviation of times to peak strain of the 16 segments divided by the RR interval. A global performance index (GPI) was calculated as (global 3D strain × torsion)/SDI. The area under the receiver operating characteristic curve was calculated to determine the capability of various echocardiographic indices to discriminate between patients and controls.

Results

Compared with controls, patients had significantly reduced LV global 3D strain (P < .001), torsion (P < .001), and GPI (P < .001) and greater SDI (P < .001). All except the basal anteroseptal segment in patients had reduced regional 3D strain compared with controls (P < .05 for all). Global 3D strain (P = .018), SDI (P = .003), and GPI (P = .02) were correlated with cumulative anthracycline dose. The areas under the curves for GPI, global 3D strain, 1/SDI, torsion, and ejection fraction were 0.92, 0.79, 0.79, 0.79, and 0.78, respectively. A GPI cutoff of 10.6°/cm had sensitivity of 84.9% and specificity of 81.6% of differentiating patients from controls.

Conclusions

Three-dimensional speckle-tracking echocardiography enables the derivation of an index of LV global performance that incorporates LV 3D strain, dyssynchrony, and torsion for the sensitive detection of altered LV mechanics in childhood cancer survivors.

Section snippets

Subjects

This was a case-control study. Fifty-three anthracycline-treated survivors of childhood cancers who had been off treatment for ≥1 year were consecutively recruited from the oncology clinic. The following data were collected from the case notes: diagnosis, duration of follow-up, cumulative dose of anthracyclines, clinical evidence of heart failure, and the need for cardiac medications. Thirty-eight control subjects were studied. The healthy volunteers were invited to participate in the study by

Subjects

The 53 patients were aged 18.6 ± 5.1 years at the time of study. The diagnoses included acute lymphoblastic leukemia (n = 26), acute myeloid leukemia (n = 10), osteosarcoma (n = 8), Burkitt lymphoma (n = 3), Hodgkin lymphoma (n = 2), non-Hodgkin lymphoma (n = 1), synovial sarcoma (n = 1), neuroblastoma (n = 1), and hepatoblastoma (n = 1). All patients had received anthracycline-based regimens, and the median cumulative anthracycline dose was 229 mg/m2 (range, 40–644 mg/m2). Patients were

Discussion

The present study represents the first attempt to interrogate global and regional performance of the left ventricle using 3D STE in childhood cancer survivors. Our findings show impairment of global and regional myocardial deformation in three dimensions, reduced torsion, and systolic dyssynchrony in adolescents and young adults after anthracycline therapy. We have further introduced a new index of global LV performance that reflects all of the aforementioned perturbations of LV mechanics and

Conclusions

Notwithstanding its limitations, the new 3D imaging modality in its present form enables the derivation of an index of LV global performance that incorporates LV 3D strain, dyssynchrony, and torsion for the sensitive detection of altered LV mechanics in childhood cancer survivors.

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  • Cited by (0)

    This study was supported by the Children's Cancer Foundation (Hong Kong, China).

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