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Echocardiography image quality of global longitudinal strain in cardio-oncology: a prospective real-world investigation

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Abstract

Background

Left-ventricular (LV) global longitudinal strain (GLS) has been reported to be a robust and sensitive marker of chemotherapy-induced cardiac damage. Image quality is paramount for accurate GLS measurements. In real-world cardio-oncology settings, the incidence of suboptimal echocardiography quality and its significance in clinical decision-making have not been well investigated. This prospective study examined the incidence and impact of suboptimal echocardiographic image quality on detecting subtle myocardial damage by chemotherapy.

Methods

Seventy-seven consecutive patients with breast cancer (age, 52 ± 12 years, 76 women, 33 with left-sided breast cancer) were included in this study. Echocardiography was performed at 3-month intervals 1 year before and after chemotherapy initiation. We classified the image quality of each echocardiographic acquisition into three groups: optimal, suboptimal, or inadequate for speckle tracking.

Results

Among the 376 examinations obtained during the cardiac monitoring, the image quality in 194 (52%) was optimal, suboptimal in 159 (42%), and inadequate in 23 (6%). The interobserver reproducibility was 0.91 in the optimal and 0.21 in the suboptimal group. In contrast, the optimal group showed progressive impairment in both GLS (p = 0.001) and LV ejection fraction (LVEF) (p < 0.001) during follow-up, and the suboptimal group showed a progressive decrease in LVEF (p = 0.006), but not in GLS (p = 0.13). Left-sided mammotomy and/or reconstruction surgery and high body mass index were significant determinants of suboptimal image quality.

Conclusions

Even in cases of minor image quality impairment, the physician should assess GLS carefully to avoid errors in crucial clinical decision-making.

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Funding

This work was supported by a grant from the Daiwa Securities Health Foundation. The funding body played no role in the design of the study and collection, analysis, and interpretation of data and writing of the manuscript.

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Author notes

  1. Noriko Iida and Kazuko Tajiri have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Clinical Laboratory, Faculty of Medicine, Tsukuba University Hospital, Tsukuba, Japan

    Noriko Iida, Rumi Sasamura-Koshizuka & Hideki Nakajima

  2. Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan

    Kazuko Tajiri, Tomoko Ishizu, Naoto Kawamatsu, Kimi Sato, Masayoshi Yamamoto & Masaki Ieda

  3. Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Tomoko Machino-Ohtsuka & Yasushi Kawakami

  4. Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Hiroko Bando

  5. Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

    Ikuo Sekine

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  1. Noriko Iida
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  2. Kazuko Tajiri
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  3. Tomoko Ishizu
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Correspondence to Tomoko Ishizu.

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Iida, N., Tajiri, K., Ishizu, T. et al. Echocardiography image quality of global longitudinal strain in cardio-oncology: a prospective real-world investigation. J Echocardiogr 20, 159–165 (2022). https://doi.org/10.1007/s12574-022-00567-8

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  • DOI: https://doi.org/10.1007/s12574-022-00567-8

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