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Cardiovascular disorders are important causes of late morbidity in childhood cancer survivors. This study assessed the usefulness of three-dimensional speckle tracking echocardiography (3D-STE) in the evaluation of global left ventricular (LV) myocardial performance in adolescent and adult survivors of childhood cancers.
53 anthracycline-treated survivors of childhood cancers aged 18.6±5.1 years and 38 controls were studied. 3D-STE was performed to assess LV global and segmental 3D strain, time-to-peak segmental 3D strain, LV torsion, end-systolic and diastolic volumes, and ejection fraction (EF). LV systolic dyssynchrony index (SDI) was calculated as % of SD of times-to-peak strain of the 16 segments/RR interval. A global performance index (GPI) was calculated as (global 3D strain-torsion)/SDI. The area under the receiver operating characteristic curve (AUC) was calculated to determine capability of various echocardiographic indices to discriminate between patients and controls.
Compared with controls, patients had significantly reduced LV global 3D strain (35.4±7.5% vs 44.6±7.8%, p<0.001), torsion (1.3±0.5/ cm vs 1.9±0.7/cm, p<0.001), GPI (6.7±3.9 /cm vs 20.2±10.6 /cm, p<0.001) and greater SDI (7.8%±3.1% vs 4.9%±1.9%, p<0.001). All except the septal basal anterior segment in patients had reduced regional 3D strain compared with controls (all p<0.05). The mean LVEF was lower (55.6%±4.2% vs. 60.1%±4.2%, p < 0.001), but within normal range, in patients than controls. Global 3D strain (r =-0.32, p =0.018), SDI(r =0.41, p =0.003) and GPI (r=-0.32, p=0.020) correlated with cumulative anthracycline dose. The AUCs of GPI, global 3D strain, SDI, torsion, and EF were 0.92, 0.79, 0.79, 0.79 and 0.78, respectively. The GPI cutoff of 10.6 /cm had a sensitivity of 84.9% and a specificity of 81.6% of differentiating patients from controls.
3D-STE enables the derivation of an index of LV global performance that incorporates LV 3D strain, dyssynchrony, and torsion for sensitive detection of altered LV mechanics in childhood cancer survivors.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: LV Systolic Function
Abstract Category: 18. Imaging: Echo
Presentation Number: 1142-350
- 2013 American College of Cardiology Foundation