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Novel Techniques of Echocardiography in the Assessment of Doxorubicin Cardiotoxicity
S36
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
87 Echocardiographic Imaging in the Dual Focus Mode Affects Two-Dimensional Speckle Tracking Strain Rate Imaging K. D’Souza ∗ , A. MacIsaac, J. Best, D. Prior St. Vincent’s Hospital, Melbourne, Australia Background: Novel cardiac imaging techniques are increasingly available to clinicians, who are rely on the results of measured parameters to diagnose disease and monitor treatment. However, one must be mindful to ensure that the measurements made accurately reflect cardiac structure and function rather than varying as a result of equipment settings. We propose that echocardiography in the dual focus mode, which is commonly performed to optimise two-dimensional image clarity, will lower frame rates and adversely affect values obtained with two-dimensional speckle tracking strain rate (SR) imaging. Methods: We selected 10 subjects with normal echocardiograms, and obtained images suitable for SR analysis in both the dual (DF) and single focus (SF) modes. Image frame rates were recorded during both focus modes, and radial and longitudinal SR and strain measurements were made at six standard sites in the parasternal short axis and apical four chamber views. Results: SR and strain results are presented, with differences between focus modes analysed with paired t-testing. Data represent mean ± S.D., signif: significance, S: systolic, E: early and A: late diastolic. Parameter
Radial DF
Radial SF
Signif
Long DF
Long DF
Signif
Frame rate
41 ± 2
57 ± 2
p < 0.001
40 ± 2
57 ± 2
p < 0.001
SR S
1.7 ± 0.5
2.0 ± 0.8
p = 0.016
1.1 ± 0.4
1.1 ± 0.3
p = 0.62
SR E
1.3 ± 0.3
1.9 ± 0.5
p < 0.001
1.3 ± 0.5
1.5 ± 0.6
p = 0.006
SR A
0.8 ± 0.2
1.0 ± 0.5
p = 0.024
0.9 ± 0.4
0.9 ± 0.5
p = 0.031
Strain
43.9 ± 13.9
50.8 ± 16.9
p = 0.001
17.9 ± 4.9
18.5 ± 4.7
p = 0.41
Conclusions: Dual focus imaging significantly lowers the frame rate, resulting in lower SR and strain values that may be mistaken for the presence of diseased myocardium. doi:10.1016/j.hlc.2007.06.092 88 Novel Techniques of Echocardiography in the Assessment of Doxorubicin Cardiotoxicity K. D’Souza ∗ , A. MacIsaac, J. Best, D. Prior St. Vincent’s Hospital, Melbourne, Australia Background: Doxorubicin (DOX) chemotherapy is frequently used, but cardiotoxicity is detectable even at low dose (183 mg/m2 ). As cancer survival increases with chemotherapy, DOX-induced morbidity must be recognised early and treated promptly. Methods: Twenty patients (15 women, 5 men; mean age 54 years) receiving DOX underwent echocardiography and clinical assessment at four time-points (A: pre-DOX, B:
half-way through, C: 1 week and D: 3 months after DOX). Echocardiography included mitral inflow Doppler, mitral propagation velocity (Vp), tissue velocity imaging (TVI) and strain rate (SR) imaging. Results: Mean DOX dose was 270 mg/m2 . Conventional markers of global systolic and diastolic function (ejection fraction, mitral inflow velocity, Vp, and annular TVI) did not change. Parameters of regional systolic and diastolic myocardial function decreased significantly with DOX. Table shows myocardial TVI results (mean ± S.D., S = peak myocardial systolic velocity, E = early diastolic myocardial velocity). Peak systolic SR also decreased significantly with DOX. Parameter
A
B
C
D
Significance
Basal–lateral S (cm/s)
5.5 ± 0.9
4.9 ± 1.7
5.7 ± 2.9
4.3 ± 2.6
P = 0.013
Basal–lateral E (cm/s)
7.9 ± 3.7
7.1 ± 4.4
6.8 ± 4.2
6.1 ± 3.9
P = 0.007
Basal–septal S (cm/s)
5.6 ± 0.9
5.4 ± 1.7
5.7 ± 2.3
4.9 ± 1.8
P = 0.016
Basal–septal E (cm/s)
7.3 ± 2.2
6.7 ± 2.8
6.7 ± 3.5
6.2 ± 3.1
P = 0.12
Conclusion: Changes in parameters of regional myocardial systolic and diastolic function using TVI and SR imaging are present early after moderate DOX doses. Their detection may enhance diagnosis of DOX cardiotoxicity, facilitating early treatment. doi:10.1016/j.hlc.2007.06.093 89 Outcomes and Diagnostic Accuracy of 16-Slice MultiDetector Computed Tomography Angiography in Symptomatic Patients with a Non-Diagnostic Stress Test R.F. Duncan 1,∗ , V.C. Eling 1 , M.A. Brown 1,2 , A. Carbone 1 , D.P.B. Chew 3 , M. Korlaet 2 , M. Leung 1 , M.I. Worthley 1 , C. Lott 2 , S.G. Worthley 1 Royal Adelaide Hospital, SA, Australia; 2 Adelaide Cardiac Imaging, Wakefield Hospital, Adelaide, SA, Australia; 3 Flinders Medical Centre, Adelaide, SA, Australia 1 CRC,
Aim: To evaluate the diagnostic accuracy of 16-slice multidetector computed tomography coronary angiography (MDCTA) for detecting coronary artery stenoses, compared to invasive coronary angiography (ICA), and assess the predictive power of MDCTA for determining future cardiac events in patients presenting with anginal symptoms and an equivocal stress test. Methods: Patients (n = 153) with anginal symptoms and a non-diagnostic stress test were prospectively evaluated by 16-slice MDCTA. Invasive coronary angiography (ICA) (n = 39) was performed as clinically indicated. Coronary artery segments (CAS) were evaluated by MDCTA for the presence of ≥50% stenosis and compared to ICA. Followup for patients undergoing MDCTA ± ICA was completed at 36.4 ± 26.4 months. The number of cardiac events during this period was recorded. Results: A total 1331 of 1530 (87.0%) of CAS were suitable for analysis by MDCTA. Of 39 patients who underwent ICA, significant stenoses were detected in 32 of 328 segments and MDCTA correctly identified 28 (87.5%) of these.
Abstracts
Heart, Lung and Circulation 2007;16:S1–S201
ABSTRACTS
87 Echocardiographic Imaging in the Dual Focus Mode Affects Two-Dimensional Speckle Tracking Strain Rate Imaging K. D’Souza ∗ , A. MacIsaac, J. Best, D. Prior St. Vincent’s Hospital, Melbourne, Australia Background: Novel cardiac imaging techniques are increasingly available to clinicians, who are rely on the results of measured parameters to diagnose disease and monitor treatment. However, one must be mindful to ensure that the measurements made accurately reflect cardiac structure and function rather than varying as a result of equipment settings. We propose that echocardiography in the dual focus mode, which is commonly performed to optimise two-dimensional image clarity, will lower frame rates and adversely affect values obtained with two-dimensional speckle tracking strain rate (SR) imaging. Methods: We selected 10 subjects with normal echocardiograms, and obtained images suitable for SR analysis in both the dual (DF) and single focus (SF) modes. Image frame rates were recorded during both focus modes, and radial and longitudinal SR and strain measurements were made at six standard sites in the parasternal short axis and apical four chamber views. Results: SR and strain results are presented, with differences between focus modes analysed with paired t-testing. Data represent mean ± S.D., signif: significance, S: systolic, E: early and A: late diastolic. Parameter
Radial DF
Radial SF
Signif
Long DF
Long DF
Signif
Frame rate
41 ± 2
57 ± 2
p < 0.001
40 ± 2
57 ± 2
p < 0.001
SR S
1.7 ± 0.5
2.0 ± 0.8
p = 0.016
1.1 ± 0.4
1.1 ± 0.3
p = 0.62
SR E
1.3 ± 0.3
1.9 ± 0.5
p < 0.001
1.3 ± 0.5
1.5 ± 0.6
p = 0.006
SR A
0.8 ± 0.2
1.0 ± 0.5
p = 0.024
0.9 ± 0.4
0.9 ± 0.5
p = 0.031
Strain
43.9 ± 13.9
50.8 ± 16.9
p = 0.001
17.9 ± 4.9
18.5 ± 4.7
p = 0.41
Conclusions: Dual focus imaging significantly lowers the frame rate, resulting in lower SR and strain values that may be mistaken for the presence of diseased myocardium. doi:10.1016/j.hlc.2007.06.092 88 Novel Techniques of Echocardiography in the Assessment of Doxorubicin Cardiotoxicity K. D’Souza ∗ , A. MacIsaac, J. Best, D. Prior St. Vincent’s Hospital, Melbourne, Australia Background: Doxorubicin (DOX) chemotherapy is frequently used, but cardiotoxicity is detectable even at low dose (183 mg/m2 ). As cancer survival increases with chemotherapy, DOX-induced morbidity must be recognised early and treated promptly. Methods: Twenty patients (15 women, 5 men; mean age 54 years) receiving DOX underwent echocardiography and clinical assessment at four time-points (A: pre-DOX, B:
half-way through, C: 1 week and D: 3 months after DOX). Echocardiography included mitral inflow Doppler, mitral propagation velocity (Vp), tissue velocity imaging (TVI) and strain rate (SR) imaging. Results: Mean DOX dose was 270 mg/m2 . Conventional markers of global systolic and diastolic function (ejection fraction, mitral inflow velocity, Vp, and annular TVI) did not change. Parameters of regional systolic and diastolic myocardial function decreased significantly with DOX. Table shows myocardial TVI results (mean ± S.D., S = peak myocardial systolic velocity, E = early diastolic myocardial velocity). Peak systolic SR also decreased significantly with DOX. Parameter
A
B
C
D
Significance
Basal–lateral S (cm/s)
5.5 ± 0.9
4.9 ± 1.7
5.7 ± 2.9
4.3 ± 2.6
P = 0.013
Basal–lateral E (cm/s)
7.9 ± 3.7
7.1 ± 4.4
6.8 ± 4.2
6.1 ± 3.9
P = 0.007
Basal–septal S (cm/s)
5.6 ± 0.9
5.4 ± 1.7
5.7 ± 2.3
4.9 ± 1.8
P = 0.016
Basal–septal E (cm/s)
7.3 ± 2.2
6.7 ± 2.8
6.7 ± 3.5
6.2 ± 3.1
P = 0.12
Conclusion: Changes in parameters of regional myocardial systolic and diastolic function using TVI and SR imaging are present early after moderate DOX doses. Their detection may enhance diagnosis of DOX cardiotoxicity, facilitating early treatment. doi:10.1016/j.hlc.2007.06.093 89 Outcomes and Diagnostic Accuracy of 16-Slice MultiDetector Computed Tomography Angiography in Symptomatic Patients with a Non-Diagnostic Stress Test R.F. Duncan 1,∗ , V.C. Eling 1 , M.A. Brown 1,2 , A. Carbone 1 , D.P.B. Chew 3 , M. Korlaet 2 , M. Leung 1 , M.I. Worthley 1 , C. Lott 2 , S.G. Worthley 1 Royal Adelaide Hospital, SA, Australia; 2 Adelaide Cardiac Imaging, Wakefield Hospital, Adelaide, SA, Australia; 3 Flinders Medical Centre, Adelaide, SA, Australia 1 CRC,
Aim: To evaluate the diagnostic accuracy of 16-slice multidetector computed tomography coronary angiography (MDCTA) for detecting coronary artery stenoses, compared to invasive coronary angiography (ICA), and assess the predictive power of MDCTA for determining future cardiac events in patients presenting with anginal symptoms and an equivocal stress test. Methods: Patients (n = 153) with anginal symptoms and a non-diagnostic stress test were prospectively evaluated by 16-slice MDCTA. Invasive coronary angiography (ICA) (n = 39) was performed as clinically indicated. Coronary artery segments (CAS) were evaluated by MDCTA for the presence of ≥50% stenosis and compared to ICA. Followup for patients undergoing MDCTA ± ICA was completed at 36.4 ± 26.4 months. The number of cardiac events during this period was recorded. Results: A total 1331 of 1530 (87.0%) of CAS were suitable for analysis by MDCTA. Of 39 patients who underwent ICA, significant stenoses were detected in 32 of 328 segments and MDCTA correctly identified 28 (87.5%) of these.