Panel says 3D echo is key to monitoring chemo-related cardiac dysfunction

A panel of experts from the American Society of Echocardiography and European Association of Cardiovascular Imaging has issued a consensus statement defining chemotherapy-related cardiac dysfunction, and supporting 3D echocardiography as the preferred technique for detecting this dysfunction.

The statement, published in the September issue of the Journal of the American Society of Echocardiography, defined chemo-related cardiac dysfunction as a decrease in left ventricular ejection fraction (LVEF) of more than 10 percentage points, to a value less than 53 percent, the normal reference value for 2D echocardiography.

Decreases should be confirmed by repeated cardiac imaging, performed two to three weeks after baseline measurements of decrease in LVEF, according to the statement. The panel also said this LVEF decrease can be further categorized as symptomatic or asymptomatic or with regard to reversibility.

“Three-dimensional echocardiography is the preferred technique for monitoring LV function and detecting [chemotherapy-related cardiac dysfunction] in patients with cancer,” wrote Juan Carlos Plana, MD, FASE, of the Cleveland Clinic and chair of the panel, and colleagues. “Advantages include better accuracy in detecting LVEF below the lower limit of normal, better reproducibility, and lower temporal variability compared with [2D echocardiography] in patients with cancer treated with chemotherapy.”

The panel noted that cost, availability, a need for trained operators and a high reliance on image quality currently limit the application of 3D echo in the oncologic setting.