Echocardiography versus Cardiac MRI for Measurement of Left Ventricular Ejection Fraction in Individuals with Cancer and Suspected Cardiotoxicity

Muhummad Sohaib Nazir*, Joseph Okafor, Theodore Murphy, Maria Sol Andres, Sivatharshini Ramalingham, Stuart D Rosen, Amedeo Chiribiri, Sven Plein, Sanjay Prasad, Raad Mohiaddin, Dudley J Pennell, A John Baksi, Rajdeep Khattar, Alexander R Lyon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Purpose: To compare left ventricular ejection fraction (LVEF) measured with echocardiography and cardiac MRI in individuals with cancer and suspected cardiotoxicity and assess the potential effect on downstream clinical decision-making. Materials and Methods: In this prospective, single-center observational cohort study, participants underwent same-day two-dimensional (2D) echocardiography and cardiac MRI between 2011 and 2021. Participants with suboptimal image quality were excluded. A subset of 74 participants also underwent three-dimensional (3D) echocardiography. The agreement of LVEF derived from each modality was assessed using Bland-Altman analysis and at relevant thresholds for cardiotoxicity. Results: A total of 745 participants (mean age, 60 years ± 5 [SD]; 460 [61.7%] female participants) underwent same-day echocar-diography and cardiac MRI. According to Bland-Altman analysis, the mean bias was –3.7% ± 7.6 (95% limits of agreement [LOA]: –18.5% to 11.1%) for 2D echocardiography versus cardiac MRI. In 74 participants who underwent cardiac MRI, 3D echocardiogra-phy, and 2D echocardiography, the mean LVEFs were 60.0% ± 10.4, 58.4% ± 9.4, and 57.2% ± 8.9, respectively (P < .001). At the 50% LVEF threshold for detection of cardiotoxicity, there was disagreement for 9.3% of participants with 2D echocardiography and cardiac MRI. Agreement was better with 3D echocardiography and cardiac MRI (mean bias, –1.6% ± 6.3 [95% LOA: –13.9% to 10.7%]) compared with 2D echocardiography and cardiac MRI (mean bias, –2.8% ± 6.3 [95% LOA: –15.2% to 9.6%]; P = .016). Conclusion: Two-dimensional echocardiography had variations of ±15% for LVEF measurement compared with cardiac MRI in participants with cancer and led to misclassification of approximately 10% of participants for cardiotoxicity detection. Three-dimensional echocardiography had better agreement with cardiac MRI and should be used as first-line imaging.

Original languageEnglish
Article numbere230048
JournalRadiology: Cardiothoracic Imaging
Issue number1
Early online date11 Jan 2024
Publication statusPublished - Feb 2024


  • Female
  • Humans
  • Middle Aged
  • Male
  • Stroke Volume
  • Ventricular Function, Left
  • Cardiotoxicity/diagnostic imaging
  • Prospective Studies
  • Magnetic Resonance Imaging
  • Echocardiography
  • Neoplasms/diagnostic imaging


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