Discriminative ability of conventional echocardiography and tissue Doppler imaging techniques for the detection of subclinical cardiotoxic effects of treatment with anthracyclines

Livia Kapusta, Johan M. Thijssen, Jacqueline Groot-Loonen, Johannes A.M. Van Druten, Otto Daniëls

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

This study investigated improvement of diagnosing myocardial damage caused by anthracyclines using tissue Doppler imaging (TDI). The optimal set of conventional echocardiographic and/or TDI parameters, needed for the discrimination of survivors from healthy controls, was retrospectively assessed. A total of 60 patients and 99 controls, age range 8.5 to 17.6 years, were studied. The survivors received 50 to 400 mg/m2 cumulative dose of anthracyclines, with a mean follow-up of 7.3 (± 2.3) years. The parameters used in the discriminant score (S-score) were selected from a large set of 51 echocardiographic parameters, using logistic regression analysis (stepwise selection). The correct classification probability (C-index) and the generalized distance (d) between the distributions of S-scores were used to measure the overall discriminative performance of each echocardiographic technique separately and in combination. The overall discriminative performance of the conventional echo-Doppler parameters (C = 77.3%, d = 1.04) was lower than that of the TDI (C = 84.2%, d = 1.37); the highest C-index was obtained using both techniques (C = 89.2%, d = 1.66). The set of parameters includes: LV fractional shortening and MV early diastolic flow velocity, two long-axis and five apical 4-CV TDI wall velocities (systolic and diastolic). In the patient group, the S-score was positively associated with cumulative dose of anthracyclines (p = 0.05) and duration of treatment (p = 0.01). The diagnostic index S-score, based on a limited number of variables from both techniques simultaneously, could retrospectively discriminate asymptomatic children with anthracycline-induced cardiomyopathy from healthy controls. The potentials of the S-score for serial and prospective studies are further investigated.

Original languageEnglish
Pages (from-to)1605-1614
Number of pages10
JournalUltrasound in Medicine and Biology
Volume27
Issue number12
DOIs
StatePublished - 2001
Externally publishedYes

Funding

FundersFunder number
Dutch Cancer Society
Stichting Vrienden KOC Nijmegen

    Keywords

    • Anthracyclines
    • Cardiotoxicity
    • Discriminative ability
    • Echocardiography
    • Multivariate statistics
    • Tissue Doppler imaging

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