Key result
Prior anthracycline exposure is linked to impaired strain-derived contractile reserve during dobutamine stress echocardiography.
Why the study?
Abnormal left ventricular contractile reserve may help detect cardiomyopathy in childhood cancer survivors following cardiotoxic treatment, but its evaluation using dobutamine stress echocardiography combined with myocardial strain needed assessment.
Does dobutamine stress echocardiography with myocardial strain detect impaired myocardial contractile reserve in childhood cancer survivors previously treated with anthracyclines?
Cohort (n=106)
Single-blind
No
Does dobutamine stress echocardiography with myocardial strain detect impaired myocardial contractile reserve in childhood cancer survivors previously treated with anthracyclines?
Strain measures during low-dose dobutamine stress echocardiography can detect impaired myocardial contractile reserve in asymptomatic childhood cancer survivors treated with anthracyclines, potentially identifying those at risk for heart failure.
Answers are grounded in this paper and cite their sources.
Strain measures during dobutamine stress may detect subclinical impairment in anthracycline survivors; leaves open prognostic value and surveillance role.
Abnormal left ventricular contractile reserve (LVCR) is associated with adverse cardiac outcomes in different patient cohorts and might be useful in the detection of cardiomyopathy in childhood cancer survivors (CCS) after cardiotoxic treatment. The aim of this study was to evaluate LVCR by dobutamine stress echocardiography (DSE) combined with measures of myocardial strain in CCS previously treated with anthracyclines (AC). Fifty-three CCS (age 25.34 ± 2.44 years, 35 male) and 53 healthy controls (age 24.40 ± 2.40 years, 32 male) were included. Subjects were examined with echocardiography at rest, at low-dose (5 micrograms/kg/min), and at high-dose (40 micrograms/kg/min) dobutamine infusion. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), strain rate (GSR), and early diastolic strain rate (GEDSR) at different DSE phases were used as measures of LVCR. The mean follow-up time among CCS was 15.8 ± 5.8 years. GLS, GSR, and LVEF were lower at rest in CCS compared to controls (p ≤ 0.03). LVEF was within the normal range in CCS. ΔGLS, ΔGSR, and ΔGEDSR but not ΔLVEF were lower in CCS compared to controls after both low- (p ≤ 0.048) and high-dose dobutamine infusion (p ≤ 0.023). We conclude that strain measures during low-dose DSE detect impaired myocardial contractile reserve in young CCS treated with AC at 15-year follow-up. Thus, DSE may help identify asymptomatic CCS at risk for heart failure and allows for tailored follow-up accordingly.
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Broberg et al. (2023) conducted a cohort in Childhood cancer survivorship after cardiotoxic anthracycline treatment (n=106). Prior childhood anthracycline treatment evaluated by dobutamine stress echocardiography vs. Healthy age- and sex-matched controls was evaluated on Abnormal global longitudinal strain (GLS) during low-dose dobutamine stress echocardiography (5 μg/kg/min) (p=0.003). Childhood cancer survivors treated with anthracyclines had impaired strain-derived contractile reserve (ΔGLS, ΔGSR, ΔGEDSR) during low-dose (p≤0.048) and high-dose (p≤0.023) dobutamine stress.
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