Utility of prechemotherapy echocardiographical assessment of cardiac abnormalities

Echocardiography provides both morphological and functional information offering a potential advantage over nuclear medicine gated blood pool scans which only estimate ejection fraction. This additional information may be relevant to management of patients receiving potentially cardiotoxic cancer treatment.

We retrospectively audited all prechemotherapy echocardiograms (ECHO) ordered by medical oncologists at our institution over a 36 months period. The primary objective was to determine the frequency of cardiac abnormality detection on the initial ECHO. We also looked at the frequency of clinically relevant cardiac abnormalities other than ejection fraction abnormalities including diastolic dysfunction, intracardiac shunts, moderate-severe valvular abnormalities, pulmonary hypertension, ventricular hypertrophy, pericardial effusion, wall motional abnormalities, ventricular dysfunction/dilatation, cardiac tumours and congenital anomalies.

Baseline ECHOs were analysed in 217 consecutive patients. Female patients comprised 89% of population, and the majority had breast cancer (75.5%). The median age of the patients at the time of ECHO was 55 years (range, 16 to 87); 13.4% of patients had at least one clinically relevant abnormality on ECHO. Systolic and moderate diastolic dysfunctions were seen in 5% and 2.7%, respectively. Aortic stenosis was seen in five (2.3%) patients. Atrial septal defects were seen in two patients, moderate mitral regurgitations in two patients and left atrial tumour in one patient. A total of 7.4% of patients had abnormalities, which would not have been detected by gated blood pool scan (GBPS). The ECHO resulted in change in chemotherapy plan in 2.8% and referral to cardiology in 3.7%.

Our retrospective analysis suggests that prechemotherapy ECHO can provide more useful clinical information than the GBPS, which may impact on clinical management of cancer patients.