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Handheld Device for Detecting Heart Dysfunction in Anthracycline-Exposed Survivors of Childhood Cancer

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Key Points

  • The handheld device Vivio was more accurate than standard two-dimensional echocardiography and comparable with cardiac magnetic resonance (CMR) imaging in screening for cardiac dysfunction in very long-term childhood cancer survivors who had been treated with anthracycline chemotherapy.
  • Using CMR imaging as the gold standard, Vivio displayed high sensitivity and a low false-negative rate for the identification of individuals with abnormal left ventricular ejection fraction (85.7% and 14.3%, respectively).

Cardiovascular complications, such as anthracycline-related heart failure, are a leading cause of morbidity and mortality in survivors of childhood cancer, often developing at a time when these survivors are least engaged in long-term survivorship care, prompting the need for new paradigms in clinical care and chronic disease screening. 

The findings from a new study show how a novel handheld mobile health platform, Vivio, can be utilized to accurately screen for cardiac dysfunction in very long-term childhood cancer survivors. The study by Armenian et al compared the accuracy of Vivio with echocardiography and cardiac magnetic resonance (CMR) imaging to detect anthracycline-related cardiac dysfunction in survivors of childhood cancer and found that the device was more accurate than two-dimensional echocardiography and comparable to CMR. The finding has the potential to change clinical care for patients diagnosed with cardiac dysfunction and allow accessible, real-time monitoring of disease without the lag-time between imaging and the interpretation of results. The study is published in Clinical Cancer Research.

Study Methodology

The researchers recruited 191 study participants, 50.7% female, from the Childhood Cancer Survivorship Clinic at City of Hope in Duarte, California, from November 2014 to May 2017. Eligibility criteria included a cancer diagnosis before the age of 22, 2 or more years since completion of cancer treatment, and exposure to anthracylcine chemotherapy. The median time from diagnosis was 15.8 years.

The researchers then compared Vivio, a prototype handheld instrument that collects pulse waves and phonocardiogram data from the carotid artery and streams the data to a smart phone or tablet, with both echocardiography and CMR imaging.

Study Findings

The researchers found that echocardiography overestimated mean left ventricular ejection fraction (EF) by 4.9% (< .001); linear regression analysis confirmed a proportional bias when compared with CMR (t= 3.1, P <0.001). There was no difference between mean left ventricular ejection fraction (EF) derived from Vivio and from CMR (–0.2%, P = .68). The detection of cardiac dysfunction via echocardiography was poor when compared with CMR (Echo EF < 45% [sensitivity, 14.3%], Echo EF < 50% [sensitivity, 28.6%]). Sensitivity was substantially better for Vivio-based measurements (EF < 45% or EF < 50% [sensitivity, 85.7%]).

“This study is the first step in thinking about new paradigms of long-term monitoring and care delivery for cancer survivors who are at risk for severe and life-threatening health conditions,” said Saro H. Armenian, DO, MPH, Director of the Childhood Cancer Survivorship Clinic at City of Hope and the lead author of this study, in a statement. “It’s important to think about more proactive and convenient approaches for early detection, early surveillance, and early prevention to help potentially reverse heart disease before it becomes clinically apparent in this population.”

Dr. Armenian is the corresponding author of this study.

Funding for this study was provided by the Caltech-City of Hope Biomedical Research Initiative and the Leukemia & Lymphoma Society Scholar Award for Clinical Research. Vivio is a product of Avicena, LLC, in which several authors of this study hold equity, employment agreements, and consulting agreements. For disclosure of potential conflicts of interest by the study authors, see the study abstract.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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