Myocardial Strain during Surveillance Screening Is Associated with Future Cardiac Dysfunction among Survivors of Childhood, Adolescent and Young Adult-Onset Cancer

Q: What are the key findings of this study?

Echocardiographic longitudinal and circumferential strain inversely correlated with fractional shortening (p=0.039 and p<0.001) and predicted FS ≤27% with an AUC of 0.906 in young cancer survivors.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Childhood, adolescent, and young adult (C-AYA) cancer survivors treated with anthracycline/anthracenedione chemotherapy (n=189). Intervention: Echocardiography-based longitudinal strain (LS) and circumferential strain (CS) surveillance vs. Survivors without a reduction of >5 fractional shortening (FS) units from pre-treatment to most recent echocardiogram. Primary outcome: Longitudinal fractional shortening (FS) and prediction of left ventricular dysfunction (FS ≤ 27%) (AUC 0.906 for predicting FS ≤ 27% (mixed model slope: LS -0.129, p=0.039; CS -0.413, p<0.001), 95% CI 0.850-0.962, p=<0.001).

Q: What does this research mean for the field?

Echocardiographic longitudinal and circumferential myocardial strain predict future left ventricular dysfunction (fractional shortening ≤ 27%) with high diagnostic accuracy (AUC 0.91) in childhood, adolescent, and young adult cancer survivors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the relationship between longitudinal and circumferential myocardial strain and fractional shortening among childhood, adolescent, and young adult cancer survivors.

Wendy Bottinor; Xiaoyan Deng; Dipankar Bandyopadhyay; Gary W. Coburn; Corey Havens; Melissa A. Carr; Daniel Saurers; Chantelle Judkins; Wu Gong; Chang Yu; Debra L. Friedman; Scott C. Borinstein; Jonathan H. Soslow

doi:10.3390/cancers15082349

April 18, 2023CancersOpen Access

Myocardial Strain during Surveillance Screening Is Associated with Future Cardiac Dysfunction among Survivors of Childhood, Adolescent and Young Adult-Onset Cancer

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Key result

Echocardiographic strain accurately predicts left ventricular dysfunction in young cancer survivors with ~0.91 AUC.

AUC 0.906 for predicting FS ≤ 27% (mixed model slope: LS -0.129, p=0.039; CS -0.413, p<0.001)
95% CI 0.850-0.962
P<0.001
n=189

Figures

Why the study?

Serial cardiovascular screening is recommended for childhood, adolescent and young adult cancer survivors, but optimal screening strategies, including echocardiography-based myocardial strain, are not fully defined.

Does surveillance echocardiography-based longitudinal and circumferential myocardial strain associate with fractional shortening and predict future cardiac dysfunction (FS ≤ 27%) in childhood, adolescent, and young adult cancer survivors treated with anthracyclines?

Key Points

To evaluate the relationship between longitudinal and circumferential myocardial strain and fractional shortening among childhood, adolescent, and young adult cancer survivors.
Retrospective single-center cohort study evaluating 189 cancer survivors treated with anthracycline/anthracenedione chemotherapy (median age at diagnosis: 14 years; median follow-up: 1.8 years).
Measured longitudinal strain (LS) and circumferential strain (CS) on serial echocardiograms and utilized mixed-effects modeling to longitudinally estimate fractional shortening (FS).
Generated receiver operating characteristic curves to evaluate the model's accuracy in predicting clinically significant left ventricular dysfunction (defined as an FS ≤ 27%).
Trajectory changes in LS and CS diverged approximately 5 years after cancer diagnosis between survivors with versus without a subsequent decline of >5 FS units.
Mixed-effects modeling showed statistically significant inverse associations between FS and LS (-0.129, p = 0.039) and between FS and CS (-0.413, p < 0.001).
The predictive model combining LS and CS distinguished survivors with an FS ≤ 27% with an area under the curve of 91% (AUC 0.906, 95% CI: 0.850–0.962).

Study Design

Type

Cohort (n=189)

Blinding

Image analysis performed by sonographers and cardiologist blinded to clinical outcome

Multicenter

No

Structured PICO

Does surveillance echocardiography-based longitudinal and circumferential myocardial strain associate with fractional shortening and predict future cardiac dysfunction (FS ≤ 27%) in childhood, adolescent, and young adult cancer survivors treated with anthracyclines?

P

Population

189 childhood, adolescent, and young adult cancer survivors (median age 14 years at diagnosis, 45% female) treated with anthracycline/anthracenedione chemotherapy at a single US center, followed for a median of 1.8 years.

E

Exposure

Serial echocardiographic measurement of left ventricular longitudinal strain (LS) and circumferential strain (CS) during surveillance screening

C

Comparator

Comparison between survivors with a reduction of >5 fractional shortening (FS) units from pre-treatment to most recent echocardiogram versus those without a >5 unit reduction; also compared models using LS alone, CS alone, and LS+CS combined

O

Outcome

Association of longitudinal strain (LS) and circumferential strain (CS) with fractional shortening (FS) longitudinally, and diagnostic accuracy (ROC AUC) of the combined LS and CS model to predict clinically significant LV systolic dysfunction defined as FS ≤ 27%surrogate

Main Result

Effect estimate: AUC 0.906 for predicting FS ≤ 27% (mixed model slope: LS -0.129, p=0.039; CS -0.413, p<0.001) (95% CI 0.850-0.962)

p-value: p=<0.001

Limitations

Retrospective study design causing variability in available echocardiogram images and image quality, hindering Simpson's bi-plane LVEF measurement
Information on dexrazoxane use was not uniformly available and not accounted for
Obesity was not accounted for in the model
Single-center study limiting generalizability
Retrospective study design with variability in available echocardiogram images and image quality, preventing Simpson's bi-plane LVEF measurements in many patients
Lack of uniform data on dexrazoxane use
Obesity was not accounted for in the statistical model
Single-center study design limiting generalizability

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Implication

Adding longitudinal and circumferential myocardial strain to routine echocardiographic surveillance in young cancer survivors can help identify patients at risk for subsequent left ventricular systolic dysfunction (FS ≤ 27%), particularly starting 5 years after diagnosis.

Abstract

Cardiovascular disease is a leading contributor to mortality among childhood, adolescent and young adult (C-AYA) cancer survivors. While serial cardiovascular screening is recommended in this population, optimal screening strategies, including the use of echocardiography-based myocardial strain, are not fully defined. Our objective was to determine the relationship between longitudinal and circumferential strain (LS, CS) and fractional shortening (FS) among survivors. This single-center cohort study retrospectively measured LS and CS among C-AYAs treated with anthracycline/anthracenedione chemotherapy. The trajectory of LS and CS values over time were examined among two groups of survivors: those who experienced a reduction of >5 fractional shortening (FS) units from pre-treatment to the most recent echocardiogram, and those who did not. Using mixed modeling, LS and CS were used to estimate FS longitudinally. A receiver operator characteristic curve was generated to determine the ability of our model to correctly predict an FS ≤ 27%. A total of 189 survivors with a median age of 14 years at diagnosis were included. Among the two survivor groups, the trajectory of LS and CS differed approximately five years from cancer diagnosis. A statistically significant inverse relationship was demonstrated between FS and LS −0.129, p = 0.039, as well as FS and CS −0.413, p < 0.001. The area under the curve for an FS ≤ 27% was 91%. Among C-AYAs, myocardial strain measurements may improve the identification of individuals with cardiotoxicity, thereby allowing earlier intervention.

Discussion

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Cite This Study

Bottinor et al. (2023) conducted a cohort in Childhood, adolescent, and young adult (C-AYA) cancer survivors treated with anthracycline/anthracenedione chemotherapy (n=189). Echocardiography-based longitudinal strain (LS) and circumferential strain (CS) surveillance vs. Survivors without a reduction of >5 fractional shortening (FS) units from pre-treatment to most recent echocardiogram was evaluated on Longitudinal fractional shortening (FS) and prediction of left ventricular dysfunction (FS ≤ 27%) (AUC 0.906 for predicting FS ≤ 27% (mixed model slope: LS -0.129, p=0.039; CS -0.413, p<0.001), 95% CI 0.850-0.962, p=<0.001). Echocardiographic longitudinal and circumferential strain inversely correlated with fractional shortening (p=0.039 and p<0.001) and predicted FS ≤27% with an AUC of 0.906 in young cancer survivors.

synapsesocial.com/papers/6a7f06cd8ba53d470169a71e https://doi.org/10.3390/cancers15082349

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Myocardial Strain during Surveillance Screening Is Associated with Future Cardiac Dysfunction among Survivors of Childhood, Adolescent and Young Adult-Onset Cancer

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Myocardial Strain during Surveillance Screening Is Associated with Future Cardiac Dysfunction among Survivors of Childhood, Adolescent and Young Adult-Onset Cancer

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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