QF2-005 - Influence of Modality-Based Threshold Criteria on the Diagnosis of Cancer Therapeutics-related Cardiac Dysfunction (CTRCD): What is the correct threshold for CMR?

Friday, February 14, 2020

11:12 AM – 11:15 AM

Location: Sabal/Sago (Meeting Room in Exhibit Hall)

Background: Current criteria for Cancer Therapeutics-related Cardiac Dysfunction (CTRCD) have adopted echocardiography-based thresholds for the detection of a meaningful change in left ventricular ejection fraction (LVEF) to below the technique’s lower limit of normal (LLN). While ≥10% absolute drop in LVEF was justified for this modality, the meaningful change measurable by CMR is ≥5% with a different LLN reference. In this study we examine the influence of applying CMR-based criteria versus echocardiography-based criteria for the definition of CTRCD in a cohort of 308 patients who collectively underwent 1239 surveillance CMR studies.

Methods: Patients were prospectively enrolled in the Cardiotoxicity Prevention Research Initiative (CAPRI) Registry, launched in 2015, aimed at evaluating the value of CMR-based surveillance of Cancer Therapeutics-related Cardiac Dysfunction (CTRCD). To date, 573 cancer patients have undergone 1841 non-contrast CMR studies. Of these, 308 were enrolled at baseline (pre-chemotherapy) and have completed at least 1 surveillance study (performed at 3-month intervals until 24-months). Patients with any baseline cardiomyopathy (defined as an LVEF ≤50%) were excluded. Overall, 1239 CMR studies were analyzed using standard operational procedures to obtain chamber volumes and function. The prevalence of CTRCD according to Echo-based criteria (CTRCDecho), defined as ≥10% drop in LVEF to < 53%, versus CMR-based criteria (CTRCDcmr), defined as ≥5% drop in LVEF to < 56%, was assessed.

Results: Mean age was 53.3±13.4 years with the majority of patients being female (n=242, 79%). Referral diagnosis was breast cancer in 195 patients (63%) and lymphoma in 101 (33%). Baseline clinical and CMR findings are presented in table 1. The mean baseline LVEF was 64.9±5.5 (range 52.3% to 83.7%). The respective prevalence of CTRCD at each timepoint is presented in Figure 1 using both CTRCDecho and CTRCDcmr criteria. The observed timepoint specific prevalence of CTRCD was generally low using CTRCDecho criteria, not exceeding 5%. In contrast, application of CTRCDcmr criteria demonstrated prevalence ranging up to 15.9%. Overall, the cumulative incidence of CTRCD (at any time point) was 8.8% using CTRCDecho criteria versus 20.5% using CTRCDcmr criteria.

Conclusion: CMR is a unique imaging modality with different test variability and LLN to that of echocardiography. Active discussion regarding how we define CTRCD by unique imaging modalities is urgently required, as are large-scale studies assessing the impact of clinical decision making based on such criteria.

Presenting Author(s)

Dina Labib, MD, FSCMR

PhD student
University of Calgary

Disclosure: Disclosure information not submitted.

Primary Author(s)

Dina Labib, MD, FSCMR

PhD student
University of Calgary

Disclosure: Disclosure information not submitted.

Co-Author(s)

SD

Steven Dykstra, MSc, BEng

PhD Student
Libin Cardiovascular Institute of Alberta, University of Calgary

Disclosure: Disclosure information not submitted.
ZS

Zdenka Slavikova, BSc

Stephenson Cardiac Imaging Centre

Disclosure: Disclosure information not submitted.
YM

Yoko Mikami, MD, PhD

Core Laboratory Manager
Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute of Alberta, University of Calgary

Disclosure: Disclosure information not submitted.
KY

Karen Yee, MSc, MPH

Alberta Health Services

Disclosure: Disclosure information not submitted.
JF

Jacqueline Flewitt, MSc

Biomedical Engineer
Libin Cardiovascular Institute of Alberta, University of Calgary

Disclosure: Disclosure information not submitted.
MS

Michelle Seib, RN

RN, Research Coordinator
Libin Cardiovascular Institute of Alberta, University of Calgary

Disclosure: Disclosure information not submitted.
SR

Sandra Rivest, RN

RN
Stephenson Cardiac Imaging Center

Disclosure: Disclosure information not submitted.
RS

Rosa Sandonato, BN, BSc

Clinical Research Nurse
University of Calgary

Disclosure: Disclosure information not submitted.
AS

Alessandro Satriano

Senior Cardiac Imaging Software Technician
Stephenson Cardiac Imaging Centre, University of Calgary

Disclosure: Disclosure information not submitted.
Bobby Heydari, MD, MPH

Assistant Professor
University of Calgary

Disclosure: Disclosure information not submitted.
AH

Andrew Howarth, MD, PhD

Assistant Professor
Libin Cardiovascular Institute of Alberta, University of Calgary

Disclosure: Disclosure information not submitted.
CL

Carmen Lydell, MD

Clinical Assistant Professor, Clinical Co-Director,
Libin Cardiovascular Institute of Alberta, University of Calgary

Disclosure: Disclosure information not submitted.
PF

Peter D. Faris, PhD

Director, Research Facilitation
University of Calgary

Disclosure: Disclosure information not submitted.
EP

Edith Pituskin, PhD

University of Alberta

Disclosure: Disclosure information not submitted.
WC

Winson Y. Cheung, MD, MPH

University of Calgary

Disclosure: Disclosure information not submitted.
JL

Joon Lee, PhD

University of Calgary

Disclosure: Disclosure information not submitted.
James White, MD

Professor of Medicine
Libin Cardiovascular Institute of Alberta, University of Calgary

Disclosure: Cohesic Inc. (Individual(s) Involved: Spouse/Partner, Products/Services: Diagnostic Informatics): Ownership Interest (stocks, stock options, or other ownership interest excluding diversified mutual funds)