Key result
Prior anthracycline therapy is linked to ~24% higher ECV in childhood cancer survivors versus controls.
Why the study?
Anthracycline therapy is a cornerstone of pediatric cancer treatment, but its effects on myocardial fibrosis and function in childhood cancer survivors remain to be quantified.
Does prior anthracycline therapy affect myocardial function and markers of fibrotic remodelling in childhood cancer survivors?
Cohort (n=101)
Does prior anthracycline therapy affect myocardial function and markers of fibrotic remodelling in childhood cancer survivors?
Absolute Event Rate: 25.6% vs 20.7%
p-value: p=0.003
Childhood cancer survivors treated with anthracyclines exhibit mild diffuse extracellular volume expansion and lower intracellular mass, suggesting subtle myocardial damage and myocyte loss even when asymptomatic.
May support enhanced surveillance in anthracycline survivors; leaves open whether extracellular volume expansion predicts outcomes.
AIMS: Anthracyclines are a cornerstone of paediatric cancer treatment. We aimed to quantify myocardial cardiac magnetic resonance (CMR) native T1 (NT1) and extracellular volume fraction (ECV) as markers of fibrosis in a cohort of childhood cancer survivors (CCS). METHODS AND RESULTS: A cohort of CCS in remission underwent CMR T1 mapping. Diastolic function was assessed by echocardiography. Results were compared to a cohort of normal controls of similar age and gender. Fifty-five CCS and 46 controls were included. Both groups had similar mean left ventricular (LV) NT1 values (999 ± 36 vs. 1007 ± 32 ms, P = 0.27); ECV was higher (25.6 ± 6.9 vs. 20.7 ± 2.4%, P = 0.003) and intracellular mass was lower (37.5 ± 8.4 vs. 43.3 ± 9.9g/m2, P = 0.02) in CCS. The CCS group had lower LV ejection fraction (EF) and LV mass index with otherwise normal diastolic function in all but one patient. The proportion of subjects with elevated ECV compared to controls did not differ between subgroups with normal or reduced LV EF (22% vs. 28%; P = 0.13) and no correlations were found between LVEF and ECV. While average values remained within normal range, mitral E/E' (6.6 ± 1.6 vs. 5.9 ± 0.9, P = 0.02) was higher in CCS. Neither NT1 nor ECV correlated with diastolic function indices or cumulative anthracycline dose. CONCLUSIONS: There is evidence for mild diffuse extracellular volume expansion in some asymptomatic CCS; myocyte loss could be part of the mechanism, accompanied by subtle changes in systolic and diastolic function. These findings suggest mild myocardial damage and remodelling after anthracycline treatment in some CCS which requires continued monitoring.
No takes yet. Share an insight, caveat, or question.
Mawad et al. (2020) conducted a cohort in Childhood cancer survivors (n=101). Anthracycline therapy vs. Normal controls was evaluated on Extracellular volume fraction (ECV) (p=0.003). Childhood cancer survivors had higher extracellular volume fraction (25.6% vs 20.7%, P=0.003) than controls, suggesting mild diffuse extracellular volume expansion after anthracycline therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: