Echocardiography protocol for early detection of cardiac dysfunction in childhood cancer survivors in the multicenter DCCSS LATER 2 CARD study: Design, feasibility, and reproducibility
Echocardiography, vol. 38, pp. 951–963
Abstract
BACKGROUND: Cardiotoxicity is a well-known side effect after anthracyclines and chest radiotherapy in childhood cancer survivors (CCS). The DCCSS LATER 2 CARD (cardiology) study includes evaluation of echocardiographic measurements for early identification of CCS at highest risk of developing heart failure. This paper describes the design, feasibility, and reproducibility of the echocardiography protocol. METHODS: Echocardiograms from CCS and sibling controls were prospectively obtained at the participating centers and centrally analyzed. We describe the image acquisition, measurement protocol, and software-specific considerations for myocardial strain analyses. We report the feasibility of the primary outcomes of systolic and diastolic function, as well as reproducibility analyses in 30 subjects. RESULTS: We obtained 1,679 echocardiograms. Biplane ejection fraction (LVEF) measurement was feasible in 91% and 96% of CCS and siblings, respectively, global longitudinal strain (GLS) in 80% and 91%, global circumferential strain (GCS) in 86% and 89%, and ≥2 diastolic function parameters in 99% and 100%, right ventricle free wall strain (RVFWS) in 57% and 65%, and left atrial reservoir strain (LASr) in 72% and 79%. Intra-class correlation coefficients for inter-observer variability were 0.85 for LVEF, 0.76 for GLS, 0.70 for GCS, 0.89 for RVFWS and 0.89 for LASr. Intra-class correlation coefficients for intra-observer variability were 0.87 for LVEF, 0.82 for GLS, 0.82 for GCS, 0.85 for RVFWS and 0.79 for LASr. CONCLUSION: The DCCSS LATER 2 CARD study includes a protocolized echocardiogram, with feasible and reproducible primary outcome measurements. This ensures high-quality outcome data for prevalence estimates and for reliable comparison of cardiac function parameters.
Authors 24
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Remy Merkx corresponding
Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Department of Medical Imaging/Radiology Medical UltraSound Imaging Centre Radboud university medical center Nijmegen The Netherlands
Department of Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud university medical center, Nijmegen, The Netherlands
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Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Department of Cardiology Radboud university medical center Nijmegen The Netherlands
Department of Cardiology, Radboud university medical center, Nijmegen, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Pediatric Oncology Amsterdam UMC VU University Amsterdam The Netherlands
Department of Pediatric Oncology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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Affiliation as printed
Trial‐ and Data Center Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Department of Medical Imaging/Radiology Medical UltraSound Imaging Centre Radboud university medical center Nijmegen The Netherlands
Department of Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud university medical center, Nijmegen, The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Department of Hematology Radboud university medical center Nijmegen The Netherlands
Department of Hematology, Radboud university medical center, Nijmegen, The Netherlands
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Marloes Louwerens Aachen Department of Internal Medicine Leiden University Medical Center Leiden The Netherlands Department of Internal Medicine
Leiden University Medical Center
Affiliation as printed
Department of Internal Medicine Leiden University Medical Center Leiden The Netherlands
Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Department of Cardiology Radboud university medical center Nijmegen The Netherlands
Department of Cardiology, Radboud university medical center, Nijmegen, The Netherlands
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Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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University Medical Center Utrecht
Affiliation as printed
Department of Cardiology University Medical Center Utrecht Utrecht The Netherlands
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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University Medical Center Groningen · Beatrix Kinderziekenhuis · Princess Máxima Center
Affiliation as printed
Department of Pediatric Oncology Beatrix Children's Hospital University Medical Center Groningen Groningen The Netherlands
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
Department of Pediatric Oncology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Affiliation as printed
Princess Máxima Center for Pediatric Oncology Utrecht The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center
Affiliation as printed
Department of Medical Imaging/Radiology Medical UltraSound Imaging Centre Radboud university medical center Nijmegen The Netherlands
Department of Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud university medical center, Nijmegen, The Netherlands
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Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Clinical and Experimental Cardiology Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Radboud University Nijmegen · Tel Aviv University · Tel Aviv Sourasky Medical Center · Radboud University Medical Center · Amalia Kinderziekenhuis
Affiliation as printed
Department of Pediatric Cardiology Amalia Children’s Hospital Radboud University Medical Center Nijmegen The Netherlands
Department of Pediatrics Pediatric Cardiology Unit Tel Aviv Sourasky Medical Center Sackler School of Medicine Tel Aviv University Tel Aviv Israel
Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
Department of Pediatrics, Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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