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. 2014 Oct;15(10):1063-93.
doi: 10.1093/ehjci/jeu192.

Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Juan Carlos Plana  1 , Maurizio Galderisi  2 , Ana Barac  3 , Michael S Ewer  4 , Bonnie Ky  5 , Marielle Scherrer-Crosbie  6 , Javier Ganame  7 , Igal A Sebag  8 , Deborah A Agler  1 , Luigi P Badano  9 , Jose Banchs  4 , Daniela Cardinale  10 , Joseph Carver  11 , Manuel Cerqueira  1 , Jeanne M DeCara  12 , Thor Edvardsen  13 , Scott D Flamm  1 , Thomas Force  14 , Brian P Griffin  1 , Guy Jerusalem  15 , Jennifer E Liu  16 , Andreia Magalhães  17 , Thomas Marwick  18 , Liza Y Sanchez  4 , Rosa Sicari  19 , Hector R Villarraga  20 , Patrizio Lancellotti  15
Affiliations

Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Juan Carlos Plana et al. Eur Heart J Cardiovasc Imaging. 2014 Oct.
No abstract available

Keywords: Biomarkers; Chemotherapy; Doxorubicin; Early detection; Left ventricular dysfunction; Strain; Three-dimensional echocardiography; Trastuzumab.

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Figures

Figure 1
Figure 1
Calculation of LVEF using the biplane Simpson's method. (A) Apical two-chamber view obtained at end-diastole. (B) Apical two-chamber view obtained at end-systole.
Figure 2
Figure 2
(A) Tricuspid annular plane systolic excursion (TAPSE) obtained from an apical chamber view in patient receiving anthracycline-based therapy. The TAPSE is normal, measuring 2.26 cm (abnormal <1.6 cm). (B) Pulse Doppler peak systolic velocity at the tricuspid valve annulus in a patient 6 months after completion of trastuzumab-based therapy. The measurement is normal at 18 cm/sec (abnormal <10 cm/sec).
Figure 3
Figure 3
Transoesophageal apical four-chamber and 3D reconstruction in an 86-year-old woman with marantic endocarditis, in the setting of metastatic pancreatic cancer. Please note the diffuse involvement of the edge of the anterior and posterior leaflets.
Figure 4
Figure 4
Parasternal long-axis view of a patient with metastatic lung cancer. Echo-lucent spaces are seen anterior (pericardial effusion [PEff]) and posterior to the descending aorta (pleural effusion [Plr-Eff]). Echo-lucent space is also seen anterior to the free wall of the right ventricle (pericardial effusion). Findings are consistent with a circumferential pericardial effusion.
Figure 5
Figure 5
Semiautomated calculation of LVEF using real-time 3DE in a patient with trastuzumab-induced CTRCD. The LVEF is abnormal at 44% (normal >53%).
Figure 6
Figure 6
End-diastolic endocardial tracing obtained from the apical four-chamber view after the administration of contrast for the calculation of LVEF using the method of disks in a patient with inadequate 2D echocardiographical images.
Figure 7
Figure 7
Reductions in pulsed DTI e′ velocities in the setting of anthracycline-induced CTRCD. (A,B) Septal and lateral e′ velocities were 8 and 15 cm/sec, respectively, before the initiation of therapy. (C,D) Septal and lateral velocities decreased to 4 and 5 cm/sec, respectively, during anthracycline therapy.
Figure 8
Figure 8
Speckle-tracking echocardiographical images illustrating GLS obtained from the apical long-axis view (A), four-chamber-view (B), and two-chamber-view (C) and strain curves and bullseye plot in a patient with breast cancer who developed CTRCD after receiving doxorubicin followed by trastuzumab. Each segment has a numeric and color-coded strain value. The cardiac dysfunction appears to be regional, with some segments more involved than others.
Figure 9
Figure 9
Bullseye plot showing GLS of the patient shown in Figure 8. (A) GLS and regional longitudinal strain at baseline. (B) GLS and regional longitudinal strain 3 months during trastuzumab-based therapy after anthracyclines. GLS has decreased from −20.6% to −14.4% (30% decrease). The decrease in GLS is therefore considered of clinical significance (>15% vs baseline).
Figure 10
Figure 10
Short-axis, end-diastolic CMR cine image demonstrating quantitative approach to left ventricular volume measurement. Endocardial contour (green) is traced in a series of images encompassing the entire ventricle during cardiac cycle. A left breast implant is seen anterior to the chest wall in a patient with a history of left mastectomy and reconstruction.
Figure 11
Figure 11
CMR image using LGE in four-chamber projection in a patient with a history of anthracycline-induced cardiomyopathy. The left ventricle is dilated with wall thinning. There is no evidence of LGE.
Figure 12
Figure 12
Cancer therapeutics regimens associated with type I and Type II CTRCD.
Figure 13
Figure 13
Initiation of a regimen potentially associated with type I toxicity. A baseline evaluation including measurements of LVEF, GLS, and troponin is recommended. If any are abnormal, a cardiology consultation is recommended. Follow-up is recommended at the completion of therapy and 6 months later for doses < 240 mg/m2 or its equivalent. Once this dose is exceeded, measurements of LVEF, GLS, and troponin are recommended before each additional 50 mg/m2.
Figure 14
Figure 14
Initiation of trastuzumab. A baseline evaluation including measurements of LVEF, GLS, and troponin is recommended. If any are abnormal, a cardiology consultation is recommended. Measurements of LVEF, GLS, and troponins are recommended every 3 months.
Figure 15
Figure 15
Initiation of trastuzumab after regimen associated with type I toxicity. A baseline evaluation including measurements of LVEF, GLS, and troponin is recommended. If any are abnormal, a cardiology consultation is recommended. Measurements of LVEF, GLS, and troponin are recommended every 3 months during therapy and 6 months later.
Figure 16
Figure 16
Early detection of sub-clinical LV dysfunction using GLS. In the absence of adjudication of CTRCD, it is recommended to use GLS for the identification of sub-clinical LV dysfunction. If baseline strain is available, a relative percentage decrease of >15% compared with baseline is likely to be of clinical significance, whereas a decrease of <8% is not.
Figure 17
Figure 17
Early detection of sub-clinical LV dysfunction using biomarkers.
See this image and copyright information in PMC

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