1. New Three-Dimensional Speckle-Tracking Echocardiography Identifies Global Impairment of Left Ventricular Mechanics with a High Sensitivity in Childhood Cancer Survivors
- Author
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Wei Yu, Godfrey Chi-Fung Chan, Hong-kui Yu, Yiu-fai Cheung, Daniel K. L. Cheuk, and Sophia J. Wong
- Subjects
Male ,China ,medicine.medical_specialty ,Adolescent ,Drug-Related Side Effects and Adverse Reactions ,Childhood cancer ,Echocardiography, Three-Dimensional ,Antineoplastic Agents ,Speckle tracking echocardiography ,Comorbidity ,Sensitivity and Specificity ,Ventricular Dysfunction, Left ,Young Adult ,Risk Factors ,Neoplasms ,Internal medicine ,Prevalence ,Humans ,Medicine ,Cutoff ,Anthracyclines ,Radiology, Nuclear Medicine and imaging ,Survivors ,Derivation ,Ventricular mechanics ,Ejection fraction ,Receiver operating characteristic ,business.industry ,Reproducibility of Results ,Treatment Outcome ,Cardiology ,Elasticity Imaging Techniques ,Time to peak ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
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-threeanthracycline-treated survivorsofchildhoodcancers(meanage,18.665.1years)and38 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. (J Am Soc Echocardiogr 2013;26:846-52.)
- Published
- 2013