Author + information
- Received December 11, 2017
- Revision received March 1, 2018
- Accepted March 5, 2018
- Published online August 6, 2018.
- Paaladinesh Thavendiranathan, MD, SMa,
- Tomoko Negishi, MDb,
- Marc-Andre Coté, MDc,
- Martin Penicka, MDd,
- Richard Massey, BSe,
- Goo-Yeong Cho, MDf,
- Krassimira Hristova, MDg,
- Dragos Vinereanu, MDh,
- Bogdan A. Popescu, MDh,
- Masaki Izumo, MDi,
- Kazuaki Negishi, MD, PhDb,
- Thomas H. Marwick, MBBS, PhD, MPHb,j,∗ (, )
- on behalf of the SUCCOUR Investigators
- aToronto General Hospital, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University of Toronto, Toronto, Canada
- bMenzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- cCentre de recherche du CHU de Québec, Québec, Canada
- dCardiovascular Center Aalst, OLV Clinic, Belgium, Aalst, Belgium
- eOslo University Hospital, Oslo, Norway
- fSeoul National University, Bundang Hospital, Seoul, Republic of Korea
- gNational Heart Hospital, Sofia, Bulgaria
- hUniversity of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- iSt. Marianna University School of Medicine, Kawasaki, Japan
- jBaker Heart & Diabetes Institute, Melbourne, Australia
- ↵∗Address for correspondence:
Dr. Thomas H. Marwick, Baker Heart & Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia.
Objectives The goal of this study was to compare echocardiographic measurements of global longitudinal strain (GLS) (using 3 apical views) with single-view longitudinal strain (LS, 4- or 2-chamber [4CV_LS and 2CV_LS, respectively]) for detection of cancer-therapy related cardiotoxicity.
Background GLS is useful for the detection of cardiotoxicity, but the need for repeated measurements poses a significant burden on busy echocardiography laboratories. A single-view LS measurement, possibly at point of care, could improve efficiency.
Methods Seventeen international centers prospectively recruited 108 patients (mean age 54 ± 13 years) at high risk for cardiotoxicity as part of the ongoing SUCCOUR (Strain Surveillance for Improving Cardiovascular Outcomes During Chemotherapy) randomized controlled trial. Echocardiography performed at baseline and follow-up were analyzed in a core laboratory setting blinded to clinical information. Peak systolic GLS and LS were measured from raw data. Cardiotoxicity was defined by reduction in left ventricular ejection fraction >0.10 to <0.55 or a relative drop in GLS by ≥12%.
Results Cardiotoxicity developed in 46 patients by either criteria. Baseline and follow-up 2-dimensional left ventricular ejection fraction were 61 ± 4% and 58 ± 5%, respectively (p < 0.001). The baseline GLS (–20.9 ± 2.4%) was not different from 4CV_LS (–20.7 ± 2.5%; p = 0.09) or 2CV_LS (–21.1 ± 3.1%; p = 0.25). The follow-up GLS (–19.5 ± 2.4%) was also similar to 4CV_LS (–19.5 ± 2.6%; p = 0.80) and 2CV_LS (–19.7 ± 3.1%; p = 0.19). There was good correlation between GLS and 4CV_LS at baseline (r = 0.86; p < 0.001) and follow-up (r = 0.89; p < 0.001) and with 2CV_LS at baseline (r = 0.87; p < 0.001) and follow-up (r = 0.88; p < 0.001). However, there was 15% to 22% disagreement between GLS and 4CV_LS or 2CV_LS for the detection of cardiotoxicity. The interobserver and intraobserver reproducibility was higher for GLS (intraclass correlation: 0.93 to 0.95; coefficient of variance: 2.9% to 3.7%) compared with either single-chamber–based LS measurement (intraclass correlation: 0.85 to 0.91; coefficient of variance: 4.1% to 4.8%).
Conclusions Although there was good correlation between GLS and single-view LS measurements, single-view LS measurement led to disagreement in the diagnosis of cardiotoxicity in up to 22% of patients. GLS measurements were more reproducible than single-view LS. GLS based on 3 apical views should remain the preferred technique for detection of cardiotoxicity. (Strain Surveillance for Improving Cardiovascular Outcomes During Chemotherapy [SUCCOUR]; ACTRN12614000341628)
- cancer therapeutics–related cardiac dysfunction
- global longitudinal strain
- single-view longitudinal strain
The SUCCOUR trial is supported in part by a project grant (1119955) from the National Health and Medical Research Council, Canberra, Australia, and receives software and core laboratory support from GE Medical Systems. Dr. Thavendiranathan is supported by the Canadian Institutes of Health Research New Investigator Award (FRN 147814). Dr. Popescu has received research support and lecture honoraria from GE Healthcare. Dr. Marwick has received research grant support from GE Medical Systems for the SUCCOUR study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Thavendiranathan and Negishi contributed equally to this work and are joint first authors. Roxy Senior, MD, served as the Guest Editor for this paper.
- Received December 11, 2017.
- Revision received March 1, 2018.
- Accepted March 5, 2018.
- 2018 American College of Cardiology Foundation