title: New three-dimensional speckle-tracking echocardiography identifies global impairment of left ventricular mechanics with a high sensitivity in childhood cancer survivors.
abstract: BACKGROUND
  The aim of this case-control study was to assess the usefulness of three-dimensional (3D) speckle-tracking echocardiography in the evaluation of global left ventricular (LV) myocardial performance in adolescent and adult survivors of childhood cancers.
  
  
  METHODS
  Fifty-three anthracycline-treated survivors of childhood cancers (mean age, 18.6 ± 5.1 years) and 38 controls were studied. Three-dimensional speckle-tracking echocardiography was performed to assess LV 3D global and segmental strain, time to peak segmental 3D strain, LV torsion, and ejection fraction. LV systolic dyssynchrony index (SDI) was calculated as the percentage of the standard deviation of times to peak strain of the 16 segments divided by the RR interval. A global performance index (GPI) was calculated as (global 3D strain × torsion)/SDI. The area under the receiver operating characteristic curve was calculated to determine the capability of various echocardiographic indices to discriminate between patients and controls.
  
  
  RESULTS
  Compared with controls, patients had significantly reduced LV global 3D strain (P < .001), torsion (P < .001), and GPI (P < .001) and greater SDI (P < .001). All except the basal anteroseptal segment in patients had reduced regional 3D strain compared with controls (P < .05 for all). Global 3D strain (P = .018), SDI (P = .003), and GPI (P = .02) were correlated with cumulative anthracycline dose. The areas under the curves for GPI, global 3D strain, 1/SDI, torsion, and ejection fraction were 0.92, 0.79, 0.79, 0.79, and 0.78, respectively. A GPI cutoff of 10.6°/cm had sensitivity of 84.9% and specificity of 81.6% of differentiating patients from controls.
  
  
  CONCLUSIONS
  Three-dimensional speckle-tracking echocardiography enables the derivation of an index of LV global performance that incorporates LV 3D strain, dyssynchrony, and torsion for the sensitive detection of altered LV mechanics in childhood cancer survivors.
authors.affiliation: Shenzhen Children's Hospital, Guangdong, China.
authors.forename: Hong-kui
authors.initials: HK
authors.lastname: Yu
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.forename: Daniel K L
authors.initials: DK
authors.lastname: Cheuk
authors.forename: Sophia J
authors.initials: SJ
authors.lastname: Wong
authors.forename: Godfrey C F
authors.initials: GC
authors.lastname: Chan
authors.forename: Yiu-fai
authors.initials: YF
authors.lastname: Cheung
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D064420:Drug-Related Side Effects and Adverse Reactions / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D019560:Echocardiography, Three-Dimensional / Q000706:statistics & numerical data*; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000453:epidemiology; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents
keywords: 2D; 3D; 3D speckle-tracking; Childhood cancer survivors; GPI; Global performance index; LV; Left ventricular; ROC; Receiver operating characteristic; SDI; STE; Speckle-tracking echocardiography; Systolic dyssynchrony index; Three-dimensional; Two-dimensional; Ventricular mechanics