Document Detail


Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging.
MedLine Citation:
PMID:  22802310     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Gregory T 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
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-07-16
Journal Detail:
Title:  Journal of clinical oncology : official journal of the American Society of Clinical Oncology     Volume:  30     ISSN:  1527-7755     ISO Abbreviation:  J. Clin. Oncol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-09     Completed Date:  2012-10-09     Revised Date:  2013-08-13    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2876-84     Citation Subset:  IM    
Affiliation:
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mailstop 735, Memphis, TN 38105, USA. greg.armstrong@stjude.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Anthracyclines / adverse effects*
Antineoplastic Agents / adverse effects*
Cardiomyopathies / diagnosis*,  etiology
Echocardiography
Female
Humans
Magnetic Resonance Imaging
Male
Mass Screening
Middle Aged
Neoplasms / therapy*
Radiotherapy / adverse effects*
Survivors
Young Adult
Grant Support
ID/Acronym/Agency:
CA 21765/CA/NCI NIH HHS
Chemical
Reg. No./Substance:
0/Anthracyclines; 0/Antineoplastic Agents
Comments/Corrections

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