超声心动图与心脏磁共振成像在测量癌症患者左心室射血分数和疑似心脏毒性方面的比较

IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Radiology. Cardiothoracic imaging Pub Date : 2024-02-01 DOI:10.1148/ryct.230048
Muhummad Sohaib Nazir, Joseph Okafor, Theodore Murphy, Maria Sol Andres, Sivatharshini Ramalingham, Stuart D Rosen, Amedeo Chiribiri, Sven Plein, Sanjay Prasad, Raad Mohiaddin, Dudley J Pennell, A John Baksi, Rajdeep Khattar, Alexander R Lyon
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The agreement of LVEF derived from each modality was assessed using Bland-Altman analysis and at relevant thresholds for cardiotoxicity. Results A total of 745 participants (mean age, 60 years ± 5 [SD]; 460 [61.7%] female participants) underwent same-day echocardiography and cardiac MRI. According to Bland-Altman analysis, the mean bias was -3.7% ± 7.6 (95% limits of agreement [LOA]: -18.5% to 11.1%) for 2D echocardiography versus cardiac MRI. In 74 participants who underwent cardiac MRI, 3D echocardiography, and 2D echocardiography, the mean LVEFs were 60.0% ± 10.4, 58.4% ± 9.4, and 57.2% ± 8.9, respectively (<i>P</i> < .001). At the 50% LVEF threshold for detection of cardiotoxicity, there was disagreement for 9.3% of participants with 2D echocardiography and cardiac MRI. 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引用次数: 0

摘要

目的 比较通过超声心动图和心脏磁共振成像测量的癌症患者左心室射血分数(LVEF)和疑似心脏毒性患者左心室射血分数(LVEF),并评估其对下游临床决策的潜在影响。材料与方法 在这项前瞻性、单中心观察性队列研究中,2011 年至 2021 年间的参与者接受了当天的二维 (2D) 超声心动图和心脏核磁共振成像检查。排除了图像质量不佳的参与者。74名参与者还接受了三维(3D)超声心动图检查。采用布兰-阿尔特曼分析法和心脏毒性的相关阈值评估了每种模式得出的 LVEF 的一致性。结果 共有 745 名参与者(平均年龄为 60 岁 ± 5 [SD];460 名女性参与者 [61.7%])接受了当天的超声心动图和心脏磁共振成像检查。根据 Bland-Altman 分析,二维超声心动图与心脏磁共振成像的平均偏差为 -3.7% ± 7.6(95% 的一致性范围 [LOA]:-18.5% 至 11.1%)。在接受心脏核磁共振成像、三维超声心动图和二维超声心动图检查的 74 名参与者中,平均 LVEF 分别为 60.0% ± 10.4、58.4% ± 9.4 和 57.2% ± 8.9(P < .001)。在检测心脏毒性的50% LVEF阈值上,9.3%的参与者在二维超声心动图和心脏磁共振成像上存在分歧。与二维超声心动图和心脏磁共振成像(平均偏差为-2.8% ± 6.3 [95% LOA: -15.2%至9.6%];P = .016)相比,三维超声心动图和心脏磁共振成像的一致性更好(平均偏差为-1.6% ± 6.3 [95% LOA: -13.9%至10.7%])。结论 在癌症患者中,二维超声心动图与心脏磁共振成像相比,LVEF测量的偏差为±15%,导致约10%的患者在心脏毒性检测中被误诊。三维超声心动图与心脏磁共振成像的一致性更好,应作为一线成像。关键词超声心动图、磁共振功能成像、心脏 本文有补充材料。© RSNA, 2024.
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Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity.

Purpose To compare left ventricular ejection fraction (LVEF) measured with echocardiography and cardiac MRI in individuals with cancer and suspected cardiotoxicity and assess the potential effect on downstream clinical decision-making. Materials and Methods In this prospective, single-center observational cohort study, participants underwent same-day two-dimensional (2D) echocardiography and cardiac MRI between 2011 and 2021. Participants with suboptimal image quality were excluded. A subset of 74 participants also underwent three-dimensional (3D) echocardiography. The agreement of LVEF derived from each modality was assessed using Bland-Altman analysis and at relevant thresholds for cardiotoxicity. Results A total of 745 participants (mean age, 60 years ± 5 [SD]; 460 [61.7%] female participants) underwent same-day echocardiography and cardiac MRI. According to Bland-Altman analysis, the mean bias was -3.7% ± 7.6 (95% limits of agreement [LOA]: -18.5% to 11.1%) for 2D echocardiography versus cardiac MRI. In 74 participants who underwent cardiac MRI, 3D echocardiography, and 2D echocardiography, the mean LVEFs were 60.0% ± 10.4, 58.4% ± 9.4, and 57.2% ± 8.9, respectively (P < .001). At the 50% LVEF threshold for detection of cardiotoxicity, there was disagreement for 9.3% of participants with 2D echocardiography and cardiac MRI. Agreement was better with 3D echocardiography and cardiac MRI (mean bias, -1.6% ± 6.3 [95% LOA: -13.9% to 10.7%]) compared with 2D echocardiography and cardiac MRI (mean bias, -2.8% ± 6.3 [95% LOA: -15.2% to 9.6%]; P = .016). Conclusion Two-dimensional echocardiography had variations of ±15% for LVEF measurement compared with cardiac MRI in participants with cancer and led to misclassification of approximately 10% of participants for cardiotoxicity detection. Three-dimensional echocardiography had better agreement with cardiac MRI and should be used as first-line imaging. Keywords: Echocardiography, MR Functional Imaging, Cardiac Supplemental material is available for this article. © RSNA, 2024.

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