Systolic myocardial function measured by echocardiographic speckle-tracking and peak oxygen consumption in pediatric childhood cancer survivors—a PACCS study

Figures

• 

  Figure 1. Left and right ventricular walls and wall segments.

• 

  Figure 2. Speckle-tracking-derived longitudinal strain of basal septal wall segment (yellow line) in left ventricle four-chamber image. Post-systolic shortening (red line) is defined as late systolic longitudinal shortening appearing after the aortic valve closure (green line) in one cardiac cycle and is calculated as post-systolic index: [(peak global strain − peak systolic strain)/peak global strain] × 100%. In this example approximately {[−15% – (−10%)]/−15%} × 100% = 33%. The dashed white line represents longitudinal strain of a wall segment without post-systolic shortening.

• 

  Figure 3. Mean left ventricular global longitudinal strain was −19.7% (95% CI −20.1% to −19.3%) for childhood cancer survivors (n = 118) and −21.3% (95% CI: −22.2% to −20.3%) for controls (n = 22) (p = 0.004).

• 

  Figure 4. Mean left ventricular longitudinal z-score was −0.3 (95% CI −0.6 to −0.1) in childhood cancer survivors (n = 118) and 0.9 (95% CI: 0.2–1.5) in controls (n = 22) (p = 0.001).

• 

  Figure 5. Decreasing myocardial function measured by left ventricular global longitudinal strain was associated with decreasing peak oxygen consumption in childhood cancer survivors (PCC −0.3, p = 0.01). The analysis was adjusted for transducer/treadmill location, sex, age, and hemoglobin concentration.

• 

  Figure 6. Mean LV-LS z-score was reduced in all of the four CCS subgroups compared to the control group (all p-values ≤ 0.02). For the anthracycline naive subgroup and the subgroups treated with low, medium, and high doses of anthracyclines, z-score was −0.1 [95% CI −0.6 to 0.4], 0.1 (95% CI: −0.4 to 0.5), −0.4 (95% CI: −0.8 to −0.02), and −1.1 (95% CI: −1.8 to −0.4), respectively, vs. 0.9 (95% CI: 0.2–1.5) in the controls.

• 

  Figure 7. LV-GLS was significantly reduced in the childhood cancer survivor subgroups treated with high and medium dose of anthracyclines compared to the control group (p-values < 0.001 and p = 0.03, respectively). LV-GLS was significantly reduced in the childhood cancer survivor subgroup treated with high dose of anthracyclines [−18.0% (95% CI −19.0 to −17.2)] compared to the anthracycline naive subgroup [−20.3% (95% CI: −21.1 to −19.4)] and the subgroups treated with low dose [−20.3% (95% CI: −20.9 to −19.6)] and medium dose of anthracyclines [−19.7% (95% CI: −20.4 to −19.1)], p = 0.003, p = 0.01, and p = 0.001, respectively.