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Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer.
- Source :
-
Circulation. Cardiovascular imaging [Circ Cardiovasc Imaging] 2019 Dec; Vol. 12 (12), pp. e008869. Date of Electronic Publication: 2019 Dec 12. - Publication Year :
- 2019
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Abstract
- Background: Anthracycline-induced cardiotoxicity is a major cause of morbidity and mortality in childhood cancer survivors (CCSs). Echocardiographic myocardial strain imaging is recommended in adult patients with cancer, but its role in pediatric CCSs has not been well established. Aims of this study were to determine the prevalence of abnormalities in left ventricular strain in pediatric CCSs, to compare strain with other echocardiographic measurements and blood biomarkers, and to explore risk factors for reduced strain.<br />Methods: CCSs ≥3 years from their last anthracycline treatment were enrolled in this multicenter study and underwent a standardized functional echocardiogram and biomarker collection. Regression analysis was used to identify factors associated with longitudinal strain (LS).<br />Results: Five hundred forty-six pediatric CCSs were compared with 134 healthy controls. Abnormal left ventricular ejection fraction (<50%) and mean LS ( Z score, <-2) was found in 0.8% and 7.7% of the CCSs, respectively. LS was significantly lower in CCSs than in controls, but the absolute difference was small (0.7%). Lower LS in CCSs was associated with older current age and higher body surface area. Sex, cumulative anthracycline dose, radiotherapy, and biomarkers were not independently associated with LS. Circumferential strain, diastolic parameters, and biomarkers were not significantly different in pediatric CCSs.<br />Conclusions: Global systolic function and LS are only mildly reduced in pediatric CCSs, and most LS values are within normal range. This makes single LS measurements of limited added value in identifying CCSs at risk for cardiac dysfunction. The utility of strain imaging in the long-term follow-up of CCS remains to be demonstrated.
- Subjects :
- Adolescent
Anthracyclines therapeutic use
Canada epidemiology
Cardiotoxicity diagnosis
Cardiotoxicity epidemiology
Child
Cross-Sectional Studies
Female
Follow-Up Studies
Heart Ventricles drug effects
Heart Ventricles physiopathology
Humans
Incidence
Male
Prognosis
Systole
United States epidemiology
Ventricular Dysfunction, Left chemically induced
Ventricular Dysfunction, Left epidemiology
Anthracyclines adverse effects
Echocardiography methods
Heart Ventricles diagnostic imaging
Neoplasms drug therapy
Stroke Volume physiology
Ventricular Dysfunction, Left diagnosis
Ventricular Function, Left physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1942-0080
- Volume :
- 12
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular imaging
- Publication Type :
- Academic Journal
- Accession number :
- 31826678
- Full Text :
- https://doi.org/10.1161/CIRCIMAGING.119.008869