title: Discriminative ability of conventional echocardiography and tissue Doppler imaging techniques for the detection of subclinical cardiotoxic effects of treatment with anthracyclines.
abstract: This study investigated improvement of diagnosing myocardial damage caused by anthracyclines using tissue Doppler imaging (TDI). The optimal set of conventional echocardiographic and/or TDI parameters, needed for the discrimination of survivors from healthy controls, was retrospectively assessed. A total of 60 patients and 99 controls, age range 8.5 to 17.6 years, were studied. The survivors received 50 to 400 mg/m(2) cumulative dose of anthracyclines, with a mean follow-up of 7.3 (+/-2.3) years. The parameters used in the discriminant score (S-score) were selected from a large set of 51 echocardiographic parameters, using logistic regression analysis (stepwise selection). The correct classification probability (C-index) and the generalized distance (d) between the distributions of S-scores were used to measure the overall discriminative performance of each echocardiographic technique separately and in combination. The overall discriminative performance of the conventional echo-Doppler parameters (C = 77.3%, d = 1.04) was lower than that of the TDI (C = 84.2%, d = 1.37); the highest C-index was obtained using both techniques (C = 89.2%, d = 1.66). The set of parameters includes: LV fractional shortening and MV early diastolic flow velocity, two long-axis and five apical 4-CV TDI wall velocities (systolic and diastolic). In the patient group, the S-score was positively associated with cumulative dose of anthracyclines (p = 0.05) and duration of treatment (p = 0.01). The diagnostic index S-score, based on a limited number of variables from both techniques simultaneously, could retrospectively discriminate asymptomatic children with anthracycline-induced cardiomyopathy from healthy controls. The potentials of the S-score for serial and prospective studies are further investigated.
authors.affiliation: Children's Heart Center, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. l.Kapusta@ckskhc.azn.nl
authors.forename: L
authors.initials: L
authors.lastname: Kapusta
authors.forename: J M
authors.initials: JM
authors.lastname: Thijssen
authors.forename: J
authors.initials: J
authors.lastname: Groot-Loonen
authors.forename: J A
authors.initials: JA
authors.lastname: van Druten
authors.forename: O
authors.initials: O
authors.lastname: Daniëls
mesh_terms: D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D016002:Discriminant Analysis; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D000903:Antibiotics, Antineoplastic