Utility of apical four‐chamber longitudinal strain in the assessment of childhood cancer survivors: A multicenter study

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 41; no. 2; pp. e15766 - n/a
• Main Authors: Mosgrove, Matthew J., Sachdeva, Ritu, Stratton, Kayla L., Armenian, Saro H., Bhat, Aarti, Leger, Kasey J., Yang, Christina, Leisenring, Wendy M., Meacham, Lillian R., Sadak, Karim T., Narasimhan, Shanti L., Nathan, Paul C., Chow, Eric J., Border, William L.
• Format: Journal Article
• Language: English
• Published: United States 01.02.2024
• Subjects: apical 4‐chamber; childhood cancer survivors; echocardiography; global longitudinal strain; strain imaging; global longitudinal strain; strain imaging; childhood cancer survivors; echocardiography; apical 4-chamber
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.15766

Background A previous multicenter study showed that longitudinal changes in standard cardiac functional parameters were associated with the development of cardiomyopathy in childhood cancer survivors (CCS). Evaluation of the relationship between global longitudinal strain (GLS) changes and cardiomyopathy risk was limited, largely due to lack of quality apical 2‐ and 3‐chamber views in addition to 4‐chamber view. We sought to determine whether apical 4‐chamber longitudinal strain (A4LS) alone can serve as a suitable surrogate for GLS in this population. Methods A4LS and GLS were measured in echocardiograms with acceptable apical 2‐, 3‐, and 4‐chamber views. Correlation was evaluated using Pearson and Spearman coefficients, and agreement was evaluated with Bland–Altman plots. The ability of A4LS to identify normal and abnormal values compared to GLS as the reference was evaluated. Results Among a total of 632 reviewed echocardiograms, we identified 130 echocardiograms from 56 patients with adequate views (38% female; mean age at cancer diagnosis 8.3 years; mean follow‐up 9.4 years). Correlation coefficients between A4LS and GLS were .89 (Pearson) and .85 (Spearman), with Bland–Altman plot of GLS—A4LS showing a mean difference of −.71 ± 1.8. Compared with GLS as the gold standard, A4LS had a sensitivity of 86% (95% CI 79%–93%) and specificity of 82% (69%–95%) when using normal range cutoffs and 90% (82%–97%) and 70% (58%–81%) when using ±2 standard deviations. Conclusion A4LS performs well when compared with GLS in this population. Given the more recent adoption of apical 2‐ and 3‐chamber views in most pediatric echocardiography laboratories, A4LS is a reasonable stand‐alone measurement in retrospective analyses of older study cohorts and echocardiogram biorepositories. This study demonstrates that single‐plane apical 4‐chamber LV longitudinal strain performs well in discriminating normal versus abnormal longitudinal strain measurements in childhood cancer survivors. This is helpful when 3‐plane LV global longitudinal strain is not able to be evaluated either due to technical limitations or missing views in archived studies.