Accuracy of a Novel Handheld Wireless Platform for Detection of Cardiac Dysfunction in Anthracycline-Exposed Survivors of Childhood Cancer

• Published in: Clinical cancer research Vol. 24; no. 13; pp. 3119 - 3125
• Main Authors: Armenian, Saro H, Rinderknecht, Derek, Au, Kaylene, Lindenfeld, Lanie, Mills, George, Siyahian, Aida, Herrera, Claudia, Wilson, Karla, Venkataraman, Kalyanasundaram, Mascarenhas, Kristen, Tavallali, Peyman, Razavi, Marianne, Pahlevan, Niema, Detterich, Jon, Bhatia, Smita, Gharib, Morteza
• Format: Journal Article
• Language: English
• Published: United States American Association for Cancer Research Inc 01.07.2018
• Subjects: Anthracycline; Bias; Cancer; Children; Disease control; Echocardiography; Experimental design; Health risk assessment; Health risks; Heart; Heart diseases; Magnetic resonance; Magnetic resonance imaging; Medical imaging; Regression analysis; Sensitivity; Survival; Ventricle
• ISSN: 1078-0432; 1557-3265
• DOI: 10.1158/1078-0432.CCR-17-3599

Childhood cancer survivors are at risk for anthracycline-related cardiac dysfunction, often developing at a time when they are least engaged in long-term survivorship care. New paradigms in survivorship care and chronic disease screening are needed in this population. We compared the accuracy of a novel handheld mHealth platform (Vivio) as well as echocardiography for assessment of cardiac function [left ventricular ejection fraction (EF)] in childhood cancer survivors with cardiac magnetic resonance (CMR) imaging (reference). Cross-sectional study design was used. Concurrent evaluation of EF was performed using Vivio, two-dimensional (2D) echocardiography, and CMR. Differences in mean EF (2D echocardiography vs. CMR; Vivio vs. CMR) were compared using Bland-Altman plots. Linear regression was used to evaluate proportional bias. A total of 191 consecutive survivors participated [50.7% female; median time from diagnosis: 15.8 years (2-44); median anthracycline dose: 225 mg/m (25-642)]. Echocardiography overestimated mean EF by 4.9% ( < 0.001); linear regression analysis confirmed a proportional bias, when compared with CMR ( = 3.1, < 0.001). There was no difference between mean EF derived from Vivio and from CMR (-0.2%, = 0.68). The detection of cardiac dysfunction via echocardiography was poor when compared with CMR [Echo EF < 45% (sensitivity 14.3%), Echo EF < 50% (sensitivity 28.6%)]. Sensitivity was substantially better for Vivio-based measurements [EF < 45% or EF < 50% (sensitivity 85.7%)]. This accessible technology has the potential to change the day-to-day practice of clinicians caring for the large number of patients diagnosed with cardiac dysfunction and heart failure each year, allowing real-time monitoring and management of their disease without the lag-time between imaging and interpretation of results. .