Screening adult survivors of childhood cancer for cardiomyopathy

Comparison of echocardiography and cardiac magnetic resonance imaging

Gregory Armstrong, Juan Carlos Plana, Nan Zhang, Deokumar Srivastava, Daniel M. Green, Kirsten K. Ness, F. Daniel Donovan, Monika L. Metzger, Alejandro Arevalo, Jean Bernard Durand, Vijaya Joshi, Melissa M. Hudson, Leslie L. Robison, Scott D. Flamm

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Purpose: To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and Methods: Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. Results: In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as > 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF < 60%) to detect an EF less than 50% by the reference standard CMR. Conclusion: CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.

Original languageEnglish (US)
Pages (from-to)2876-2884
Number of pages9
JournalJournal of Clinical Oncology
Volume30
Issue number23
DOIs
StatePublished - Aug 22 2012

Fingerprint

Cardiomyopathies
Survivors
Echocardiography
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Three-Dimensional Echocardiography
Neoplasms
Left Ventricular Function
Population
Anthracyclines
Heart Diseases
Radiotherapy
Thorax
Guidelines
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Screening adult survivors of childhood cancer for cardiomyopathy : Comparison of echocardiography and cardiac magnetic resonance imaging. / Armstrong, Gregory; Plana, Juan Carlos; Zhang, Nan; Srivastava, Deokumar; Green, Daniel M.; Ness, Kirsten K.; Donovan, F. Daniel; Metzger, Monika L.; Arevalo, Alejandro; Durand, Jean Bernard; Joshi, Vijaya; Hudson, Melissa M.; Robison, Leslie L.; Flamm, Scott D.

In: Journal of Clinical Oncology, Vol. 30, No. 23, 22.08.2012, p. 2876-2884.

Research output: Contribution to journalArticle

Armstrong, G, Plana, JC, Zhang, N, Srivastava, D, Green, DM, Ness, KK, Donovan, FD, Metzger, ML, Arevalo, A, Durand, JB, Joshi, V, Hudson, MM, Robison, LL & Flamm, SD 2012, 'Screening adult survivors of childhood cancer for cardiomyopathy: Comparison of echocardiography and cardiac magnetic resonance imaging', Journal of Clinical Oncology, vol. 30, no. 23, pp. 2876-2884. https://doi.org/10.1200/JCO.2011.40.3584
Armstrong, Gregory ; Plana, Juan Carlos ; Zhang, Nan ; Srivastava, Deokumar ; Green, Daniel M. ; Ness, Kirsten K. ; Donovan, F. Daniel ; Metzger, Monika L. ; Arevalo, Alejandro ; Durand, Jean Bernard ; Joshi, Vijaya ; Hudson, Melissa M. ; Robison, Leslie L. ; Flamm, Scott D. / Screening adult survivors of childhood cancer for cardiomyopathy : Comparison of echocardiography and cardiac magnetic resonance imaging. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 23. pp. 2876-2884.
@article{0c17a9ac562d4995887d7a36a50d06df,
title = "Screening adult survivors of childhood cancer for cardiomyopathy: Comparison of echocardiography and cardiac magnetic resonance imaging",
abstract = "Purpose: To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and Methods: Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. Results: In this survivor population, 14{\%} (n = 16) had an ejection fraction (EF) less than 50{\%} by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32{\%}) and cardiac mass (48{\%}) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5{\%}. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25{\%} and a false-negative rate of 75{\%} for detection of EF less than 50{\%}, although 3D echocardiography had 53{\%} and 47{\%}, respectively. Twelve survivors (11{\%}) had an EF less than 50{\%} by CMR but were misclassified as > 50{\%} (range, 50{\%} to 68{\%}) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75{\%}) by using a higher 2D echocardiography cutoff (EF < 60{\%}) to detect an EF less than 50{\%} by the reference standard CMR. Conclusion: CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50{\%} to 59{\%} by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.",
author = "Gregory Armstrong and Plana, {Juan Carlos} and Nan Zhang and Deokumar Srivastava and Green, {Daniel M.} and Ness, {Kirsten K.} and Donovan, {F. Daniel} and Metzger, {Monika L.} and Alejandro Arevalo and Durand, {Jean Bernard} and Vijaya Joshi and Hudson, {Melissa M.} and Robison, {Leslie L.} and Flamm, {Scott D.}",
year = "2012",
month = "8",
day = "22",
doi = "10.1200/JCO.2011.40.3584",
language = "English (US)",
volume = "30",
pages = "2876--2884",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "23",

}

TY - JOUR

T1 - Screening adult survivors of childhood cancer for cardiomyopathy

T2 - Comparison of echocardiography and cardiac magnetic resonance imaging

AU - Armstrong, Gregory

AU - Plana, Juan Carlos

AU - Zhang, Nan

AU - Srivastava, Deokumar

AU - Green, Daniel M.

AU - Ness, Kirsten K.

AU - Donovan, F. Daniel

AU - Metzger, Monika L.

AU - Arevalo, Alejandro

AU - Durand, Jean Bernard

AU - Joshi, Vijaya

AU - Hudson, Melissa M.

AU - Robison, Leslie L.

AU - Flamm, Scott D.

PY - 2012/8/22

Y1 - 2012/8/22

N2 - Purpose: To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and Methods: Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. Results: In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as > 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF < 60%) to detect an EF less than 50% by the reference standard CMR. Conclusion: CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.

AB - Purpose: To compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and Methods: Cross-sectional, contemporaneous evaluation of LV structure and function by 2D and three-dimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. Results: In this survivor population, 14% (n = 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n = 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as > 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF < 60%) to detect an EF less than 50% by the reference standard CMR. Conclusion: CMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.

UR - http://www.scopus.com/inward/record.url?scp=84865092873&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865092873&partnerID=8YFLogxK

U2 - 10.1200/JCO.2011.40.3584

DO - 10.1200/JCO.2011.40.3584

M3 - Article

VL - 30

SP - 2876

EP - 2884

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 23

ER -