Development and Phenotype of Heart Failure in Long‐Term Survivors of Childhood Cancer: The CVSS Study

Figures

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  Figure 1. Prevalence for stages of HF, according to history of tumor entity. Prevalence of HF stage A and the composite of HF stage B to D are shown for tumor entities according to International Classification of Childhood Cancer classification in the study sample (CVSS study). Prevalence is provided with 95% CIs for HF stage A, the composite of HF stage B to D (both within the columns), and the composite of HF stage A to D. CNS indicates central nervous system; CVSS, Cardiac and Vascular Late Sequelae in Long‐Term Survivors of Childhood Cancer; HF, heart failure; M‐syndrome, metabolic syndrome; and PAD, peripheral artery disease.

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  Figure 2. Crude and adjusted prevalence of stages of HF in childhood cancer survivors compared with the general population. A, Prevalence for stages of HF in a subsample of childhood cancer survivors (N=425) compared with an age‐ and sex‐matched sample from the general population (N=1275). A 1:3 case/control ratio and 2‐year tolerance were applied for age matching. Prevalence is shown for (1) HF (all stages) and (2) HF stage A and the composite of heart failure stage B to D; P values were calculated by a proportion test. B, Poisson regression models with robust error variance were fitted to evaluate the association of former childhood cancer with prevalent HF compared with the general population (total CVSS study sample, N=929; GHS subsample, aged 35 to 50 years, N=5673). PRs are provided with 95% CIs for HF stage A and the composite of HF stage B to D with adjustment for (1) age and sex; and (2) age, sex, and cardiovascular risk factors. CVSS indicates Cardiac and Vascular Late Sequelae in Long‐Term Survivors of Childhood Cancer; GHS, Gutenberg Health Study; HF, heart failure; and PR, prevalence ratio.

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  Figure 3. Age dependency of the prevalence for HF (stage B–D) in childhood cancer survivors and the general population. Age‐dependent comparison of the prevalence for the composite of HF stage B to D in childhood cancer survivors and the general population. Conditional density plots were generated, and nonparametric bootstrap samples (n=1000) were run to estimate 95% confidence limits. Data were calculated on the basis of a CVSS study subsample, aged 30 to 45 years (N=649), and the GHS sample, aged 35 to 74 years (N=14 638). For the population data, the graph is displayed for the age range 35 to 50 years only. CVSS indicates Cardiac and Vascular Late Sequelae in Long‐Term Survivors of Childhood Cancer; GHS, Gutenberg Health Study; and HF, heart failure.