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Relationship of promising methods in the detection of anthracycline-induced cardiotoxicity in breast cancer patients.

Bulten BF, Verberne HJ, Bellersen L, Oyen WJ, Sabaté-Llobera A, Mavinkurve-Groothuis AM, Kapusta L, van Laarhoven HW, de Geus-Oei LF - Cancer Chemother. Pharmacol. (2015)

Bottom Line: The delayed planar H/M ratio is the most robust (123)I-mIBG parameter.It correlates with several conventional echocardiographic parameters, GLS, GRS and galectin-3.Of these, only GRS predicts the H/M ratio.

View Article: PubMed Central - PubMed

Affiliation: MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Zuidhorst Room 2.65, Drienerlolaan 5, PO Box 217, 7500 AE, Enschede, The Netherlands. benbulten@gmail.com.

ABSTRACT

Purpose: It remains challenging to identify patients at risk of anthracycline-induced cardiotoxicity. To better understand the different risk-stratifying approaches, we evaluated (123)I-metaiodobenzylguanidine ((123)I-mIBG) scintigraphy and its interrelationship with conventional echocardiography, 2D strain imaging and several biomarkers.

Methods: We performed (123)I-mIBG scintigraphy, conventional and strain echocardiography and biomarker (NT-proBNP, TNF-α, galectin-3, IL-6, troponin I, ST-2 and sFlt-1) assessment in 59 breast cancer survivors 1 year after anthracycline treatment. Interobserver and intermethod variability was calculated on planar and SPECT (123)I-mIBG scintigraphy, using the heart/mediastinum (H/M) ratio and washout (WO). Pearson's r and multivariate analyses were performed to identify correlations and independent predictors of (123)I-mIBG scintigraphy results.

Results: Delayed planar anterior whole-heart ROI (WH) H/M ratios and WO were the most robust (123)I-mIBG parameters. Significant correlations were observed between (123)I-mIBG parameters and several conventional echo parameters, global longitudinal and radial strain (GLS and GRS) and galectin-3. The highest Pearson's r was observed between delayed H/M ratio and GRS (Pearson's r 0.36, p = 0.01). Multivariate analysis showed that GRS was the only independent predictor of the delayed WH H/M ratio (p = 0.023).

Conclusion: The delayed planar H/M ratio is the most robust (123)I-mIBG parameter. It correlates with several conventional echocardiographic parameters, GLS, GRS and galectin-3. Of these, only GRS predicts the H/M ratio.

No MeSH data available.


Related in: MedlinePlus

The dilution effect. Early geo WH versus Sm H/M ratio showed an LCC of 0.87 (95 % CI 0.81–0.91), R2 = 0.42. The increasing intermethod difference is due to the dilution effect: the difference between cavum and myocardium increases when the myocardium has high 123I-mIBG uptake (i.e. the normal heart), and the ROI inclusion of blood pool (i.e. WH ROI) will account more heavily to the average heart count. Other LCCs were 0.79 (95 % CI 0.71–0.86, early anterior), 0.87 (95 % CI 0.81–0.91, delayed anterior) and 0.82 (95 % CI 0.74–0.88, delayed geo). Intermethod analysis of WO showed a poor correlation of 0.82 (95 % CI 0.72–0.88) for anterior images and a moderate correlation of 0.91 (95 % CI 0.85–0.94) for delayed images
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Fig3: The dilution effect. Early geo WH versus Sm H/M ratio showed an LCC of 0.87 (95 % CI 0.81–0.91), R2 = 0.42. The increasing intermethod difference is due to the dilution effect: the difference between cavum and myocardium increases when the myocardium has high 123I-mIBG uptake (i.e. the normal heart), and the ROI inclusion of blood pool (i.e. WH ROI) will account more heavily to the average heart count. Other LCCs were 0.79 (95 % CI 0.71–0.86, early anterior), 0.87 (95 % CI 0.81–0.91, delayed anterior) and 0.82 (95 % CI 0.74–0.88, delayed geo). Intermethod analysis of WO showed a poor correlation of 0.82 (95 % CI 0.72–0.88) for anterior images and a moderate correlation of 0.91 (95 % CI 0.85–0.94) for delayed images

Mentions: Interobserver correlations of WH H/M ratios were moderate, of Sm H/M ratios and WO poor (Table 2). However, mean interobserver differences were small for WH H/M ratio (Fig. 2). Intermethod variability, describing the correlation of WH and Sm ROI definition by one observer, demonstrated poor LCCs (Fig. 3).Fig. 2


Relationship of promising methods in the detection of anthracycline-induced cardiotoxicity in breast cancer patients.

Bulten BF, Verberne HJ, Bellersen L, Oyen WJ, Sabaté-Llobera A, Mavinkurve-Groothuis AM, Kapusta L, van Laarhoven HW, de Geus-Oei LF - Cancer Chemother. Pharmacol. (2015)

The dilution effect. Early geo WH versus Sm H/M ratio showed an LCC of 0.87 (95 % CI 0.81–0.91), R2 = 0.42. The increasing intermethod difference is due to the dilution effect: the difference between cavum and myocardium increases when the myocardium has high 123I-mIBG uptake (i.e. the normal heart), and the ROI inclusion of blood pool (i.e. WH ROI) will account more heavily to the average heart count. Other LCCs were 0.79 (95 % CI 0.71–0.86, early anterior), 0.87 (95 % CI 0.81–0.91, delayed anterior) and 0.82 (95 % CI 0.74–0.88, delayed geo). Intermethod analysis of WO showed a poor correlation of 0.82 (95 % CI 0.72–0.88) for anterior images and a moderate correlation of 0.91 (95 % CI 0.85–0.94) for delayed images
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612328&req=5

Fig3: The dilution effect. Early geo WH versus Sm H/M ratio showed an LCC of 0.87 (95 % CI 0.81–0.91), R2 = 0.42. The increasing intermethod difference is due to the dilution effect: the difference between cavum and myocardium increases when the myocardium has high 123I-mIBG uptake (i.e. the normal heart), and the ROI inclusion of blood pool (i.e. WH ROI) will account more heavily to the average heart count. Other LCCs were 0.79 (95 % CI 0.71–0.86, early anterior), 0.87 (95 % CI 0.81–0.91, delayed anterior) and 0.82 (95 % CI 0.74–0.88, delayed geo). Intermethod analysis of WO showed a poor correlation of 0.82 (95 % CI 0.72–0.88) for anterior images and a moderate correlation of 0.91 (95 % CI 0.85–0.94) for delayed images
Mentions: Interobserver correlations of WH H/M ratios were moderate, of Sm H/M ratios and WO poor (Table 2). However, mean interobserver differences were small for WH H/M ratio (Fig. 2). Intermethod variability, describing the correlation of WH and Sm ROI definition by one observer, demonstrated poor LCCs (Fig. 3).Fig. 2

Bottom Line: The delayed planar H/M ratio is the most robust (123)I-mIBG parameter.It correlates with several conventional echocardiographic parameters, GLS, GRS and galectin-3.Of these, only GRS predicts the H/M ratio.

View Article: PubMed Central - PubMed

Affiliation: MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Zuidhorst Room 2.65, Drienerlolaan 5, PO Box 217, 7500 AE, Enschede, The Netherlands. benbulten@gmail.com.

ABSTRACT

Purpose: It remains challenging to identify patients at risk of anthracycline-induced cardiotoxicity. To better understand the different risk-stratifying approaches, we evaluated (123)I-metaiodobenzylguanidine ((123)I-mIBG) scintigraphy and its interrelationship with conventional echocardiography, 2D strain imaging and several biomarkers.

Methods: We performed (123)I-mIBG scintigraphy, conventional and strain echocardiography and biomarker (NT-proBNP, TNF-α, galectin-3, IL-6, troponin I, ST-2 and sFlt-1) assessment in 59 breast cancer survivors 1 year after anthracycline treatment. Interobserver and intermethod variability was calculated on planar and SPECT (123)I-mIBG scintigraphy, using the heart/mediastinum (H/M) ratio and washout (WO). Pearson's r and multivariate analyses were performed to identify correlations and independent predictors of (123)I-mIBG scintigraphy results.

Results: Delayed planar anterior whole-heart ROI (WH) H/M ratios and WO were the most robust (123)I-mIBG parameters. Significant correlations were observed between (123)I-mIBG parameters and several conventional echo parameters, global longitudinal and radial strain (GLS and GRS) and galectin-3. The highest Pearson's r was observed between delayed H/M ratio and GRS (Pearson's r 0.36, p = 0.01). Multivariate analysis showed that GRS was the only independent predictor of the delayed WH H/M ratio (p = 0.023).

Conclusion: The delayed planar H/M ratio is the most robust (123)I-mIBG parameter. It correlates with several conventional echocardiographic parameters, GLS, GRS and galectin-3. Of these, only GRS predicts the H/M ratio.

No MeSH data available.


Related in: MedlinePlus