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Single versus standard multiview assessment of global longitudinal strain for the diagnosis of cardiotoxicity during cancer therapy


Thavendiranathan, P and Negishi, T and Cote, M-A and Penicka, M and Massey, R and Cho, G-Y and Hristova, K and Vinereanu, D and Popescu, BA and Izumo, M and Negishi, K and Marwick, TH, on behalf of the SUCCOUR Investigators, Single versus standard multiview assessment of global longitudinal strain for the diagnosis of cardiotoxicity during cancer therapy, JACC: Cardiovascular Imaging, 11, (8) pp. 1109-1118. ISSN 1936-878X (2018) [Refereed Article]

Copyright Statement

Copyright 2018 by the American College of Cardiology Foundation. Published by Elsevier.

DOI: doi:10.1016/j.jcmg.2018.03.003


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 toá<0.55 or a relative drop in GLS byá≥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 (pá< 0.001). The baseline GLS (-20.9 ▒ 2.4%) was not different from 4CV_LS (-20.7 ▒ 2.5%; pá= 0.09) or 2CV_LS (-21.1 ▒ 3.1%; pá= 0.25). The follow-up GLS (-19.5 ▒ 2.4%) was also similar to 4CV_LS (-19.5 ▒ 2.6%; pá= 0.80) and 2CV_LS (-19.7 ▒ 3.1%; pá= 0.19). There was good correlation between GLS and 4CV_LS at baseline (rá= 0.86; pá< 0.001) and follow-up (rá= 0.89; pá< 0.001) and with 2CV_LS at baseline (rá= 0.87; pá< 0.001) and follow-up (rá= 0.88; pá< 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.

Item Details

Item Type:Refereed Article
Keywords:cancer therapeuticsľrelated cardiac dysfunction, cardiotoxicity, global longitudinal strain, single-view longitudinal strain
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Negishi, T (Dr Tomoko Negishi)
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:128025
Year Published:2018
Web of Science® Times Cited:30
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-08-28
Last Modified:2022-08-30

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