Key result
LV strain reveals cardiac dysfunction in childhood cancer survivors, ~70% of whom show normal LVEF.
Why the study?
Most childhood cancer survivors have been exposed to cardiotoxic treatments and present with modifiable cardiovascular risk factors, motivating an evaluation of LV longitudinal strain to increase sensitivity in detecting cardiac dysfunction.
Does left ventricular longitudinal strain assessment improve the sensitivity of detecting cardiac dysfunction compared to 3D LV ejection fraction in childhood cancer survivors exposed to cardiotoxic treatments?
Cross-Sectional (n=176)
Yes
Does left ventricular longitudinal strain assessment improve the sensitivity of detecting cardiac dysfunction compared to 3D LV ejection fraction in childhood cancer survivors exposed to cardiotoxic treatments?
Left ventricular longitudinal strain is more sensitive than 3D ejection fraction for detecting subclinical cardiac dysfunction in long-term childhood cancer survivors exposed to cardiotoxic therapies.
Answers are grounded in this paper and cite their sources.
Strain may detect subclinical dysfunction missed by EF in survivors; leaves open whether routine use improves outcomes.
Background: The majority of childhood cancer survivors (CCSs) have been exposed to cardiotoxic treatments and often present with modifiable cardiovascular risk factors. Our aim was to evaluate the value of left ventricular (LV) longitudinal strain for increasing the sensitivity of cardiac dysfunction detection among CCSs. Methods: We combined two national cohorts: neuroblastoma and other childhood cancer survivors treated with anthracyclines. The final data consisted of 90 long-term CCSs exposed to anthracyclines and/or high-dose chemotherapy with autologous stem cell rescue and followed up for > 5 years and their controls ( n = 86). LV longitudinal strain was assessed with speckle tracking (Qlab) and LV ejection fraction (EF) by three-dimensional echocardiography (3DE). Results: Of the CCSs, 11% (10/90) had abnormal LV longitudinal strain (i.e., < -17.5%); of those, 70% (7/10) had normal 3DE LV EF. Multivariable linear model analysis demonstrated that follow-up time ( p = 0.027), sex ( p = 0.020), and BMI ( p = 0.002) were significantly associated with LV longitudinal strain. Conversely, cardiac risk group, hypertension, age, cumulative anthracycline dose or exposure to chest radiation were not. Conclusion: LV longitudinal strain is a more sensitive method than LV EF for the detection of cardiac dysfunction among CCSs. Therefore, LV longitudinal strain should be added to the screening panel, especially for those with modifiable cardiovascular risk factors.
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Niemelä et al. (2021) conducted a cross-sectional in Childhood cancer survivors exposed to cardiotoxic treatments (n=176). Cardiotoxic treatments (anthracyclines and/or high-dose chemotherapy) vs. Healthy controls was evaluated on Abnormal LV longitudinal strain (≤-17.5%). Among childhood cancer survivors exposed to cardiotoxic treatments, 11% had abnormal left ventricular longitudinal strain, of which 70% had a normal left ventricular ejection fraction.
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