Key result
Chest radiotherapy is linked to ~139% higher risk of abnormal GLS in childhood cancer survivors.
Why the study?
Treatment-related cardiac death is the leading non-cancer cause of mortality in adult survivors of childhood cancer, and early detection using modern echocardiography may identify high-risk survivors.
Does comprehensive echocardiographic assessment including strain imaging detect subclinical cardiac dysfunction in adult survivors of childhood cancer?
Cross-Sectional (n=1,820)
Does comprehensive echocardiographic assessment including strain imaging detect subclinical cardiac dysfunction in adult survivors of childhood cancer?
Relative Risk: 2.39 (95% CI 1.79–3.18)
Global longitudinal strain and diastolic function assessment detect a high prevalence of subclinical cardiac dysfunction in adult survivors of childhood cancer who have a normal 3D LVEF.
Advanced echo detects subclinical dysfunction in many survivors with normal LVEF; leaves open whether early intervention improves outcomes.
Background Treatment-related cardiac death is the primary non-cancer cause of mortality in adult survivors of childhood malignancies. Early detection of cardiac dysfunction using modern echocardiographic techniques may identify a high risk subset of survivors for early intervention. Objective To determine the prevalence of cardiac dysfunction in adult survivors of childhood malignancies using state of the art echocardiographic evaluation of cardiac function including strain imaging Methods Echocardiographic assessment included three dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential myocardial strain and diastolic function, graded per American Society of Echocardiography (ASE) guidelines on 1,820 adult (median age 31 [range 18-65] years) survivors of childhood cancer (median time from diagnosis 23 years [range10-48] years) exposed to either anthracycline chemotherapy (N=1,050), chest-directed radiotherapy (RT, N=306), or both therapies (N=464). Results Only 5.8% of survivors had an abnormal 3D LVEF (<50%). However, 32.1% of survivors with a normal 3D LVEF had evidence for cardiac dysfunction by either global longitudinal strain (28.0%), ASE graded diastolic assessment (8.7%), or both. Abnormal global longitudinal strain was associated with chest-directed RT (1-19.9 Gy, Rate Ratio (RR) 1.38, 95% Confidence Interval (CI) 1.14-1.66; 20-29.9 Gy, RR 1.65, 95% CI 1.31-2.08; >30 Gy, RR 2.39, 95% CI 1.79-3.18) and anthracycline dose >300 mg/m2 (RR 1.72, 95% CI 1.31-2.26). Survivors with metabolic syndrome were twice as likely to have abnormal global longitudinal strain (Rate Ratio [RR] 1.94, 95% CI 1.66-2.28) as well as abnormal diastolic function (RR 1.68, 95% CI 1.39-2.03), but not abnormal 3D LVEF (RR 1.07, 95% CI 0.74-1.53). Conclusions and Relevance Abnormal global longitudinal strain and abnormal diastolic function are more prevalent than reduced 3D LVEF and are associated with treatment exposure. They may identify a subset of survivors at higher risk for poor clinical cardiac outcome who may benefit from early medical intervention.
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Armstrong et al. (2015) conducted a cross-sectional in Adult survivors of childhood cancer (n=1,820). Chest-directed radiotherapy and anthracycline chemotherapy vs. Lower doses or unexposed was evaluated on Abnormal global longitudinal strain (RR 2.39, 95% CI 1.79-3.18). Chest-directed radiotherapy (>30 Gy) and anthracyclines (>300 mg/m2) were associated with abnormal global longitudinal strain (RR 2.39 and RR 1.72, respectively) in childhood cancer survivors.
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