Adding exercise echocardiography to resting echocardiography did not improve prediction of late cardiotoxicity, whereas mean resting fractional shortening z-character decreased from -0.18 to -0.93.
Cohort (n=92)
Does monitoring with exercise echocardiography improve the prediction of late anthracycline-induced cardiotoxicity compared to resting echocardiography alone in asymptomatic childhood cancer survivors?
Exercise echocardiography does not provide added value over resting echocardiography alone for predicting late anthracycline-induced cardiotoxicity in childhood cancer survivors.
BACKGROUND: Exercise echocardiography reveals abnormalities in asymptomatic childhood cancer survivors who previously have been treated with anthracyclines. We determined the added value of monitoring childhood cancer survivors with exercise echocardiography compared to monitoring with resting echocardiography alone to predict anthracycline-induced cardiotoxicity. Secondary aims were to evaluate change in resting cardiac function over 10 years and to determine risk factors for late cardiotoxicity. PROCEDURE: We invited a cohort of 110 originally asymptomatic anthracycline-treated childhood cancer survivors, who had undergone cardiac tests including exercise echocardiography 10.5 years earlier, for new cardiac evaluation. Each subject underwent a resting echocardiogram at both evaluations. At first evaluation a repeat echocardiogram was performed following peak exercise. Resting echocardiographic parameters were converted to z-character. RESULTS: Ninety-two of 110 survivors (mean anthracycline dose 307 mg/m(2), mean follow-up time from start of treatment 8.2 years at first and 18.8 years at second evaluation) were evaluated prospectively. Mean resting fractional shortening z-character (RFSz) decreased from -0.18 to -0.93. Higher cumulative anthracycline dose was a risk factor for a lower RFSz at late follow-up (P = 0.0002). Adding exercise fractional shortening (XFS) to a model containing RFSz did not improve prediction of abnormal RFSz at late follow-up. CONCLUSIONS: Monitoring with exercise echocardiography has no added value to monitoring with resting echocardiography alone in predicting late anthracycline-induced cardiotoxicity in childhood cancer survivors. RFSz deteriorates over time, even in originally asymptomatic patients. Previous treatment with higher cumulative anthracycline dose is the main risk factor for a lower RFSz at late follow-up.
Sieswerda et al. (2009) conducted a cohort in Asymptomatic childhood cancer survivors treated with anthracyclines (n=92). Exercise echocardiography vs. Resting echocardiography alone was evaluated on Prediction of abnormal resting fractional shortening z-character (RFSz) at late follow-up. Adding exercise echocardiography to resting echocardiography did not improve prediction of late cardiotoxicity, whereas mean resting fractional shortening z-character decreased from -0.18 to -0.93.