2D echocardiography demonstrated limited screening performance compared to CMR, with a sensitivity of 25% and a false-negative rate of 75% for detecting an ejection fraction <50%.
Cross-Sectional (n=114)
Does 2D echocardiography accurately detect left ventricular ejection fraction <50% compared to cardiac magnetic resonance imaging in adult survivors of childhood cancer?
2D echocardiography has poor sensitivity for detecting left ventricular ejection fraction <50% compared to CMR in adult survivors of childhood cancer, suggesting a need for comprehensive cardiac assessment including CMR or higher echocardiography cutoffs.
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.
Armstrong et al. (2012) conducted a cross-sectional in Adult survivors of childhood cancer (n=114). 2D echocardiography vs. Cardiac magnetic resonance (CMR) imaging was evaluated on Sensitivity for detection of ejection fraction less than 50%. 2D echocardiography demonstrated limited screening performance compared to CMR, with a sensitivity of 25% and a false-negative rate of 75% for detecting an ejection fraction <50%.