Clinical Research
Cardiac Imaging
Reproducibility of Echocardiographic Techniques for Sequential Assessment of Left Ventricular Ejection Fraction and Volumes: Application to Patients Undergoing Cancer Chemotherapy

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Objectives

The aim of this study was to identify the best echocardiographic method for sequential quantification of left ventricular (LV) ejection fraction (EF) and volumes in patients undergoing cancer chemotherapy.

Background

Decisions regarding cancer therapy are based on temporal changes of EF. However the method for EF measurement with the lowest temporal variability is unknown.

Methods

We selected patients in whom stable function in the face of chemotherapy for breast cancer was defined by stability of global longitudinal strain (GLS) at up to 5 time points (baseline, 3, 6, 9, and 12 months). In this way, changes in EF were considered to reflect temporal variability of measurements rather than cardiotoxicity. A comprehensive echocardiogram consisting of 2-dimensional (2D) and 3-dimensional (3D) acquisitions with and without contrast administration was performed at each time point. Stable LV function was defined as normal GLS (≤−16.0%) at each examination. The EF and volumes were measured with 2D-biplane Simpson's method, 2D-triplane, and 3-dimensional echocardiography (3DE) by 2 investigators blinded to any clinical data. Inter-, intra-, and test-retest variability were assessed in a subgroup. Variability was assessed by analysis of variance and compared with Levene's or t test.

Results

Among 56 patients (all female, 54 ± 13 years of age), noncontrast 3D EF, end-diastolic volume, and end-systolic volume had significantly lower temporal variability than all other methods. Contrast only decreased the temporal variability of LV end-diastolic volume measurements by the 2D biplane method. Our data suggest that a temporal variability in EF of 0.06 might occur with noncontrast 3DE due to physiological differences and measurement variability, whereas this might be >0.10 with 2D methods. Overall, 3DE also had the best intra- and inter-observer as well as test-retest variability.

Conclusions

Noncontrast 3DE was the most reproducible technique for LVEF and LV volume measurements over 1 year of follow-up.

Key Words

3D echocardiography
chemotherapy
interobserver test re-test variability
interobserver variability
longitudinal variability

Abbreviations and Acronyms

2DBi
2-dimensional biplane
2DE
2-dimensional echocardiography
2DTri
2-dimensional triplane
3DE
3-dimensional echocardiography
CI
confidence interval
COV
coefficient of variation
EDV
end-diastolic volume
EF
ejection fraction
ESV
end-systolic volume
GLS
average systolic global longitudinal strain
LV
left ventricle/ventricular
SEM
standard error of measurement

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The authors have reported that they have no relationships relevant to the contents of this paper to disclose.