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. 2014 Dec 15;20(24):6314-23.
doi: 10.1158/1078-0432.CCR-13-3490. Epub 2014 Jun 19.

Screening for cardiac dysfunction in anthracycline-exposed childhood cancer survivors

Saro H Armenian  1 , Sarah K Gelehrter  2 , Tabitha Vase  3 , Rajkumar Venkatramani  4 , Wendy Landier  3 , Karla D Wilson  3 , Claudia Herrera  3 , Leah Reichman  5 , John-David Menteer  6 , Leo Mascarenhas  4 , David R Freyer  4 , Kalyanasundaram Venkataraman  7 , Smita Bhatia  3
Affiliations

Screening for cardiac dysfunction in anthracycline-exposed childhood cancer survivors

Saro H Armenian et al. Clin Cancer Res. .

Abstract

Purpose: To examine the utility and reliability of obtaining early echocardiographic measurements of left ventricular (LV) remodeling as well as blood biomarkers of cardiac injury in asymptomatic childhood cancer survivors at risk for LV dysfunction and congestive heart failure due to past exposure to anthracycline chemotherapy.

Experimental design: Using a cross-sectional design, anthracycline-exposed childhood cancer survivors with preserved ejection fraction (EF; ≥50%) were evaluated using early echocardiographic indices and blood biomarkers of LV dysfunction. Survivors treated with ≥300 mg/m(2) anthracyclines [high risk (HR): n = 100] were compared with those treated with <300 mg/m(2) anthracyclines [low risk (LR): n = 50] and matched healthy controls (HC: n = 50). All echocardiograms were interpreted by an institutional cardiologist and a study cardiologist blinded to risk status.

Results: Time from diagnosis was comparable for HR (12.0 years) and LR (13.2 years, P = 0.8) survivors. Echocardiograms: HR had lower LV thickness-dimension ratio (Z-score: HR: -0.62, LR: -0.03, HC: -0.02; P < 0.001), increased LV wall stress (HR: 66.7 g/cm(2), LR: 56.6 g/cm(2), HC: 54.2 g/cm(2); P < 0.01), and higher myocardial performance index (HR: 0.51, LR: 0.46, HC: 0.46; P < 0.01). Interobserver correlation (clinical/blinded reading) for all echocardiographic indices was excellent (range: R = 0.76-0.97, P < 0.001). Blood biomarkers: With the exception of NT-proBNP (r = 0.28, P < 0.01), there was no correlation between blood biomarkers (B-type natriuretic peptide, Troponin-T, ST-2, Galectin-3) and LV dysfunction.

Conclusion: Childhood cancer survivors with preserved EF 10+ years from anthracycline exposure had dose-dependent changes in echocardiographic markers of LV dysfunction.

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Figures

Figure 1
Figure 1
Left ventricular (LV) echocardiographic indices by cumulative anthracycline dose (mg/m2). A) End diastolic diameter (LVEDD); B) End-systolic diameter (LVESD); C) Posterior wall thickness in diastole (LVPWD); D) Thickness-dimension ratio (LV T-D).
Figure 2
Figure 2
Left ventricular End systolic wall stress (ESWS) and Myocardial performance index (MPI) by cumulative anthracycline dose (mg/m2).
See this image and copyright information in PMC

References

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