Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity

Muhummad Sohaib Nazir; Joseph Okafor; Theodore Murphy; Maria Sol Andres; Sivatharshini Ramalingham; Stuart D Rosen; Amedeo Chiribiri; Sven Plein; Sanjay Prasad; Raad Mohiaddin; Dudley J Pennell; A John Baksi; Rajdeep Khattar; Alexander R Lyon

doi:10.1148/ryct.230048

Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity

Muhummad Sohaib Nazir^*, Joseph Okafor, Theodore Murphy, Maria Sol Andres, Sivatharshini Ramalingham, Stuart D Rosen, Amedeo Chiribiri, Sven Plein, Sanjay Prasad, Raad Mohiaddin, Dudley J Pennell, A John Baksi, Rajdeep Khattar, Alexander R Lyon

^*Corresponding author for this work

Cardiovascular Imaging

UK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals, London, UK.
Royal Brompton and Harefield Hospitals NHS Trust (Part of Guy's and St Thomas' NHS Foundation Trust), Sydney Street, London, UK.
School of Biomedical Engineering and Imaging Sciences
1Department of Hepatology, Imperial College London, London, UK. 2Institute of Liver Studies at King's College School of Medicine at King's College Hospital, London, UK. 3Institute of Human Health and Performance, University College London, London, UK. 4Department of Asthma Allergy and Lung Biology, King's College London, London, UK. 5Division of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Univ London, Birkbeck University London, University College London, University of London Royal Veterinary College, University of London, St Georges University London, Imperial College London, Kings College London, Royal Holloway University London, Queen Mary University London, Div Populat Hlth Sci & Educ
Cardiovascular Magnetic Resonance Unit (S. Prasad

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Abstract

Purpose: To compare left ventricular ejection fraction (LVEF) measured with echocardiography and cardiac MRI in individuals with cancer and suspected cardiotoxicity and assess the potential effect on downstream clinical decision-making. Materials and Methods: In this prospective, single-center observational cohort study, participants underwent same-day two-dimensional (2D) echocardiography and cardiac MRI between 2011 and 2021. Participants with suboptimal image quality were excluded. A subset of 74 participants also underwent three-dimensional (3D) echocardiography. The agreement of LVEF derived from each modality was assessed using Bland-Altman analysis and at relevant thresholds for cardiotoxicity. Results: A total of 745 participants (mean age, 60 years ± 5 [SD]; 460 [61.7%] female participants) underwent same-day echocar-diography and cardiac MRI. According to Bland-Altman analysis, the mean bias was –3.7% ± 7.6 (95% limits of agreement [LOA]: –18.5% to 11.1%) for 2D echocardiography versus cardiac MRI. In 74 participants who underwent cardiac MRI, 3D echocardiogra-phy, and 2D echocardiography, the mean LVEFs were 60.0% ± 10.4, 58.4% ± 9.4, and 57.2% ± 8.9, respectively (P < .001). At the 50% LVEF threshold for detection of cardiotoxicity, there was disagreement for 9.3% of participants with 2D echocardiography and cardiac MRI. Agreement was better with 3D echocardiography and cardiac MRI (mean bias, –1.6% ± 6.3 [95% LOA: –13.9% to 10.7%]) compared with 2D echocardiography and cardiac MRI (mean bias, –2.8% ± 6.3 [95% LOA: –15.2% to 9.6%]; P = .016). Conclusion: Two-dimensional echocardiography had variations of ±15% for LVEF measurement compared with cardiac MRI in participants with cancer and led to misclassification of approximately 10% of participants for cardiotoxicity detection. Three-dimensional echocardiography had better agreement with cardiac MRI and should be used as first-line imaging.

Original language	English
Article number	e230048
Journal	Radiology: Cardiothoracic Imaging
Volume	6
Issue number	1
Early online date	11 Jan 2024
DOIs	https://doi.org/10.1148/ryct.230048
Publication status	Published - Feb 2024

Keywords

Female
Humans
Middle Aged
Male
Stroke Volume
Ventricular Function, Left
Cardiotoxicity/diagnostic imaging
Prospective Studies
Magnetic Resonance Imaging
Echocardiography
Neoplasms/diagnostic imaging

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1148/ryct.230048

Echocardiography versus Cardiac MRI_NAZIR_Publishedonline11January2024_VoR (CC BY NC ND)Final published version, 710 KBLicence: CC BY-NC-ND

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Nazir, M. S., Okafor, J., Murphy, T., Andres, M. S., Ramalingham, S., Rosen, S. D., Chiribiri, A., Plein, S., Prasad, S., Mohiaddin, R., Pennell, D. J., Baksi, A. J., Khattar, R., & Lyon, A. R. (2024). Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity. Radiology: Cardiothoracic Imaging, 6(1), Article e230048. https://doi.org/10.1148/ryct.230048

@article{5012a251e28c4600a0f3bcbc8689b01d,

title = "Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity",

abstract = "Purpose: To compare left ventricular ejection fraction (LVEF) measured with echocardiography and cardiac MRI in individuals with cancer and suspected cardiotoxicity and assess the potential effect on downstream clinical decision-making. Materials and Methods: In this prospective, single-center observational cohort study, participants underwent same-day two-dimensional (2D) echocardiography and cardiac MRI between 2011 and 2021. Participants with suboptimal image quality were excluded. A subset of 74 participants also underwent three-dimensional (3D) echocardiography. The agreement of LVEF derived from each modality was assessed using Bland-Altman analysis and at relevant thresholds for cardiotoxicity. Results: A total of 745 participants (mean age, 60 years ± 5 [SD]; 460 [61.7%] female participants) underwent same-day echocar-diography and cardiac MRI. According to Bland-Altman analysis, the mean bias was –3.7% ± 7.6 (95% limits of agreement [LOA]: –18.5% to 11.1%) for 2D echocardiography versus cardiac MRI. In 74 participants who underwent cardiac MRI, 3D echocardiogra-phy, and 2D echocardiography, the mean LVEFs were 60.0% ± 10.4, 58.4% ± 9.4, and 57.2% ± 8.9, respectively (P < .001). At the 50% LVEF threshold for detection of cardiotoxicity, there was disagreement for 9.3% of participants with 2D echocardiography and cardiac MRI. Agreement was better with 3D echocardiography and cardiac MRI (mean bias, –1.6% ± 6.3 [95% LOA: –13.9% to 10.7%]) compared with 2D echocardiography and cardiac MRI (mean bias, –2.8% ± 6.3 [95% LOA: –15.2% to 9.6%]; P = .016). Conclusion: Two-dimensional echocardiography had variations of ±15% for LVEF measurement compared with cardiac MRI in participants with cancer and led to misclassification of approximately 10% of participants for cardiotoxicity detection. Three-dimensional echocardiography had better agreement with cardiac MRI and should be used as first-line imaging.",

keywords = "Female, Humans, Middle Aged, Male, Stroke Volume, Ventricular Function, Left, Cardiotoxicity/diagnostic imaging, Prospective Studies, Magnetic Resonance Imaging, Echocardiography, Neoplasms/diagnostic imaging",

author = "Nazir, {Muhummad Sohaib} and Joseph Okafor and Theodore Murphy and Andres, {Maria Sol} and Sivatharshini Ramalingham and Rosen, {Stuart D} and Amedeo Chiribiri and Sven Plein and Sanjay Prasad and Raad Mohiaddin and Pennell, {Dudley J} and Baksi, {A John} and Rajdeep Khattar and Lyon, {Alexander R}",

note = "Funding Information: The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy{\textquoteright}s & St Thomas{\textquoteright} NHS Foundation Trust in partnership with King{\textquoteright}s College London and King{\textquoteright}s College Hospital NHS Foundation Trust and by the NIHR MedTech Co-operative for Cardiovascular Disease at Guy{\textquoteright}s and St Thomas{\textquoteright} NHS Foundation Trust. M.S.N. supported by a NIHR Clinical Lectureship (CL-2019-17-001). S. Plein supported by the British Heart Foundation (BHF) (grant CH/16/2/32089). A.R.L. supported by the Fondation Leducq Network of Excellence in Cardio-Oncology. The Royal Brompton Cardio-Oncology Centre of Excellence supported by the The Big Heart Foundation. The views expressed are those of the authors and not necessarily those of the BHF, NHS, or the NIHR. Publisher Copyright: {\textcopyright} RSNA, 2024.",

year = "2024",

month = feb,

doi = "10.1148/ryct.230048",

language = "English",

volume = "6",

journal = "Radiology: Cardiothoracic Imaging",

issn = "2638-6135",

publisher = "Radiological Society of North America Inc.",

number = "1",

}

Nazir, MS, Okafor, J, Murphy, T, Andres, MS, Ramalingham, S, Rosen, SD, Chiribiri, A , Plein, S, Prasad, S, Mohiaddin, R, Pennell, DJ, Baksi, AJ, Khattar, R & Lyon, AR 2024, 'Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity', Radiology: Cardiothoracic Imaging, vol. 6, no. 1, e230048. https://doi.org/10.1148/ryct.230048

TY - JOUR

T1 - Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity

AU - Nazir, Muhummad Sohaib

AU - Okafor, Joseph

AU - Murphy, Theodore

AU - Andres, Maria Sol

AU - Ramalingham, Sivatharshini

AU - Rosen, Stuart D

AU - Chiribiri, Amedeo

AU - Plein, Sven

AU - Prasad, Sanjay

AU - Mohiaddin, Raad

AU - Pennell, Dudley J

AU - Baksi, A John

AU - Khattar, Rajdeep

AU - Lyon, Alexander R

N1 - Funding Information: The authors acknowledge financial support from the Department of Health through the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s & St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust and by the NIHR MedTech Co-operative for Cardiovascular Disease at Guy’s and St Thomas’ NHS Foundation Trust. M.S.N. supported by a NIHR Clinical Lectureship (CL-2019-17-001). S. Plein supported by the British Heart Foundation (BHF) (grant CH/16/2/32089). A.R.L. supported by the Fondation Leducq Network of Excellence in Cardio-Oncology. The Royal Brompton Cardio-Oncology Centre of Excellence supported by the The Big Heart Foundation. The views expressed are those of the authors and not necessarily those of the BHF, NHS, or the NIHR. Publisher Copyright: © RSNA, 2024.

PY - 2024/2

Y1 - 2024/2

N2 - Purpose: To compare left ventricular ejection fraction (LVEF) measured with echocardiography and cardiac MRI in individuals with cancer and suspected cardiotoxicity and assess the potential effect on downstream clinical decision-making. Materials and Methods: In this prospective, single-center observational cohort study, participants underwent same-day two-dimensional (2D) echocardiography and cardiac MRI between 2011 and 2021. Participants with suboptimal image quality were excluded. A subset of 74 participants also underwent three-dimensional (3D) echocardiography. The agreement of LVEF derived from each modality was assessed using Bland-Altman analysis and at relevant thresholds for cardiotoxicity. Results: A total of 745 participants (mean age, 60 years ± 5 [SD]; 460 [61.7%] female participants) underwent same-day echocar-diography and cardiac MRI. According to Bland-Altman analysis, the mean bias was –3.7% ± 7.6 (95% limits of agreement [LOA]: –18.5% to 11.1%) for 2D echocardiography versus cardiac MRI. In 74 participants who underwent cardiac MRI, 3D echocardiogra-phy, and 2D echocardiography, the mean LVEFs were 60.0% ± 10.4, 58.4% ± 9.4, and 57.2% ± 8.9, respectively (P < .001). At the 50% LVEF threshold for detection of cardiotoxicity, there was disagreement for 9.3% of participants with 2D echocardiography and cardiac MRI. Agreement was better with 3D echocardiography and cardiac MRI (mean bias, –1.6% ± 6.3 [95% LOA: –13.9% to 10.7%]) compared with 2D echocardiography and cardiac MRI (mean bias, –2.8% ± 6.3 [95% LOA: –15.2% to 9.6%]; P = .016). Conclusion: Two-dimensional echocardiography had variations of ±15% for LVEF measurement compared with cardiac MRI in participants with cancer and led to misclassification of approximately 10% of participants for cardiotoxicity detection. Three-dimensional echocardiography had better agreement with cardiac MRI and should be used as first-line imaging.

AB - Purpose: To compare left ventricular ejection fraction (LVEF) measured with echocardiography and cardiac MRI in individuals with cancer and suspected cardiotoxicity and assess the potential effect on downstream clinical decision-making. Materials and Methods: In this prospective, single-center observational cohort study, participants underwent same-day two-dimensional (2D) echocardiography and cardiac MRI between 2011 and 2021. Participants with suboptimal image quality were excluded. A subset of 74 participants also underwent three-dimensional (3D) echocardiography. The agreement of LVEF derived from each modality was assessed using Bland-Altman analysis and at relevant thresholds for cardiotoxicity. Results: A total of 745 participants (mean age, 60 years ± 5 [SD]; 460 [61.7%] female participants) underwent same-day echocar-diography and cardiac MRI. According to Bland-Altman analysis, the mean bias was –3.7% ± 7.6 (95% limits of agreement [LOA]: –18.5% to 11.1%) for 2D echocardiography versus cardiac MRI. In 74 participants who underwent cardiac MRI, 3D echocardiogra-phy, and 2D echocardiography, the mean LVEFs were 60.0% ± 10.4, 58.4% ± 9.4, and 57.2% ± 8.9, respectively (P < .001). At the 50% LVEF threshold for detection of cardiotoxicity, there was disagreement for 9.3% of participants with 2D echocardiography and cardiac MRI. Agreement was better with 3D echocardiography and cardiac MRI (mean bias, –1.6% ± 6.3 [95% LOA: –13.9% to 10.7%]) compared with 2D echocardiography and cardiac MRI (mean bias, –2.8% ± 6.3 [95% LOA: –15.2% to 9.6%]; P = .016). Conclusion: Two-dimensional echocardiography had variations of ±15% for LVEF measurement compared with cardiac MRI in participants with cancer and led to misclassification of approximately 10% of participants for cardiotoxicity detection. Three-dimensional echocardiography had better agreement with cardiac MRI and should be used as first-line imaging.

KW - Female

KW - Humans

KW - Middle Aged

KW - Male

KW - Stroke Volume

KW - Ventricular Function, Left

KW - Cardiotoxicity/diagnostic imaging

KW - Prospective Studies

KW - Magnetic Resonance Imaging

KW - Echocardiography

KW - Neoplasms/diagnostic imaging

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U2 - 10.1148/ryct.230048

DO - 10.1148/ryct.230048

M3 - Article

C2 - 38206164

SN - 2638-6135

VL - 6

JO - Radiology: Cardiothoracic Imaging

JF - Radiology: Cardiothoracic Imaging

IS - 1

M1 - e230048

ER -

Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity

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