ArticleJournal of cardiovascular medicine (Hagerstown, Md.)2025
Diagnostic accuracy of ECG and N-terminal pro B-type natriuretic peptide for cardiac dysfunction among asymptomatic long-term breast cancer survivors.
Article in Journal of cardiovascular medicine (Hagerstown, Md.), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWith a growing population of breast cancer survivors, it is important to acknowledge long-term consequences of breast cancer treatment, including left ventricular systolic dysfunction (LVSD). Although echocardiography is a reliable technique to diagnose LVSD, its limited accessibility in primary care poses challenges.
methodsA cross-sectional diagnostic accuracy study among 350 long-term breast cancer survivors, at least 5 years after breast cancer diagnosis, comparing the diagnostic performance of index tests ECG and N-terminal pro B-type natriuretic peptide (NT-proBNP) to the reference test echocardiography. LVSD was defined as left ventricular ejection fraction (LVEF) less than 54% or LVEF less than 50% on echocardiography.
resultsThe median age at time of investigation was 63 years (IQR 57-68), with a median follow-up duration since breast cancer diagnosis of 10 years (IQR 7-14). An abnormal ECG demonstrated a sensitivity of 63.0% (IQR 48.7-75.7), a corresponding specificity of 51.7 (IQR 45.8-57.6) and a negative likelihood ratio of 0.7 (IQR 0.5-1.0) for detecting a LVEF less than 54%. An abnormal ECG showed a sensitivity of 75.0 (IQR 47.6-92.7), a corresponding specificity of 50.6 (IQR 45.1-56.2) and a negative likelihood ratio of 0.5 (0.2-1.2) for detecting LVSD defined as LVEF less than 50%. The area under the curve for NT-proBNP was 0.59 (95% confidence interval: 0.50-0.68) for detecting LVEF less than 54% and 0.56 (95% confidence interval: 0.39-0.74) for detecting LVEF less than 50%. DISCUSSION: ECG and NT-proBNP are inadequate diagnostic tools to screen for LVSD among asymptomatic long-term breast cancer survivors.
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