Radionuclide ventriculography phase analysis for risk stratification of patients undergoing cardiotoxic cancer therapy
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Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow, UK School of Physics and Astronomy, University of Glasgow, Glasgow, UK School of Mathematics & Statistics, University of Glasgow, Glasgow, UK School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
Received Feb 20, 2020; accepted Jun 29, 2020 doi:10.1007/s12350-020-02277-z
Background. Accurate diagnostic tools to identify patients at risk of cancer therapy-related cardiac dysfunction (CTRCD) are critical. For patients undergoing cardiotoxic cancer therapy, ejection fraction assessment using radionuclide ventriculography (RNVG) is commonly used for serial assessment of left ventricular (LV) function. Methods. In this retrospective study, approximate entropy (ApEn), synchrony, entropy, and standard deviation from the phase histogram (phase SD) were investigated as potential early markers of LV dysfunction to predict CTRCD. These phase parameters were calculated from the baseline RNVG phase image for 177 breast cancer patients before commencing cardiotoxic therapy. Results. Of the 177 patients, 11 had a decline in left ventricular ejection fraction (LVEF) of over 10% to an LVEF below 50% after treatment had commenced. This patient group had a significantly higher ApEn at baseline to those who maintained a normal LVEF throughout treatment. Of the parameters investigated, ApEn was superior for predicting the risk of CTRCD. Combining ApEn with the baseline LVEF further improved the discrimination between the groups. Conclusions. The results suggest that RNVG phase analysis using approximate entropy may aid in the detection of sub-clinical LV contraction abnormalities, not detectable by baseline LVEF measurement, predicting a subsequent decline in LVEF. (J Nucl Cardiol 2020) Key Words: RNA: planar Æ dyssynchrony Æ diagnostic and prognostic application Æ image analysis
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02277-z) contains supplementary material, which is available to authorized users. The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarises the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on SpringerLink.com.
Reprint requests: K. A. Jones, MSc, Department of Nuclear Cardiology, Glasgow Royal Infirmary, Glasgow; [email protected] 1071-3581/$34.00 Copyright Ó 2020 The Author(s)
Jones et al Radionuclide ventriculography phase analysis
Abbreviations CTRCD Cancer therapy-related cardiac dysfunction LVEF Left ventricular ejection fraction RNVG Radionuclide ventriculography MUGA Multi-gated acquisition study GLS Global longitudinal strain LBBB Left bundle branch block MI Myocardial Infarction ApEn Approximate entropy SD Standard deviation
INTRODUCTION Survival from breast cancer has improved substantially over the last 20 to 30 years due to earlier diagnosis and advances in treatment with adjuvant radiotherapy and chemotherapy. However, car
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