Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
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
Gregory T
GT
Armstrong
Juan Carlos
JC
Plana
Nan
N
Zhang
Deokumar
D
Srivastava
Daniel M
DM
Green
Kirsten K
KK
Ness
F
F
Daniel Donovan
Monika L
ML
Metzger
Alejandro
A
Arevalo
Jean-Bernard
JB
Durand
Vijaya
V
Joshi
Melissa M
MM
Hudson
Leslie L
LL
Robison
Scott D
SD
Flamm
D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors; D055815:Young Adult
D018943:Anthracyclines; D000970:Antineoplastic Agents