Accuracy of left ventricular ejection fraction by contemporary multiple gated acquisition scanning in patients with cancer: comparison with cardiovascular magnetic resonance.
BACKGROUND
Multiple gated acquisition scanning (MUGA) is a common imaging modality for baseline and serial assessment of left ventricular ejection fraction (LVEF) for cardiotoxicity risk assessment prior to, surveillance during, and surveillance after administration of potentially cardiotoxic cancer treatment. The objective of this study was to compare the accuracy of left ventricular ejection fractions (LVEF) obtained by contemporary clinical multiple gated acquisition scans (MUGA) with reference LVEFs from cardiovascular magnetic resonance (CMR) in consecutive patients with cancer.


METHODS
In a cross-sectional study, we compared MUGA clinical and CMR reference LVEFs in 75 patients with cancer who had both studies within 30 days. Misclassification was assessed using the two most common thresholds of LVEF used in cardiotoxicity clinical studies and practice: 50 and 55%.


RESULTS
Compared to CMR reference LVEFs, MUGA clinical LVEFs were only lower by a mean of 1.5% (48.5% vs. 50.0%, p = 0.17). However, the limits of agreement between MUGA clinical and CMR reference LVEFs were wide at -19.4 to 16.5%. At LVEF thresholds of 50 and 55%, there was misclassification of 35 and 20% of cancer patients, respectively.


CONCLUSIONS
MUGA clinical LVEFs are only modestly accurate when compared with CMR reference LVEFs. These data have significant implications on clinical research and patient care of a population with, or at risk for, cardiotoxicity.
Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
Hans
H
Huang
Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
Prabhjot S
PS
Nijjar
Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
Jeffrey R
JR
Misialek
Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
Anne
A
Blaes
University of Minnesota Medical School, Minneapolis, MN, USA.
Nicholas P
NP
Derrico
Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA.
Felipe
F
Kazmirczak
Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, USA.|Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
Igor
I
Klem
Division of Cardiology, Duke University Medical Center, Durham, NC, USA.|Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Afshin
A
Farzaneh-Far
Cardiovascular Division, Department of Medicine, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA. cshenoy@umn.edu.
Chetan
C
Shenoy
D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D055424:Cardiac-Gated Imaging Techniques; D066126:Cardiotoxicity; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging / Q000379:methods*; D015203:Reproducibility of Results; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects*
D000970:Antineoplastic Agents
Cancer; Cardio-oncology; Cardiovascular magnetic resonance; Ejection fraction; MUGA; Onco-cardiology