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. 2015 Jun 16;65(23):2511-22.
doi: 10.1016/j.jacc.2015.04.013.

Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer: Results From the St. Jude Lifetime Cohort Study

Gregory T Armstrong  1 , Vijaya M Joshi  2 , Kirsten K Ness  3 , Thomas H Marwick  4 , Nan Zhang  5 , DeoKumar Srivastava  5 , Brian P Griffin  6 , Richard A Grimm  6 , James Thomas  7 , Dermot Phelan  6 , Patrick Collier  6 , Kevin R Krull  3 , Daniel A Mulrooney  8 , Daniel M Green  3 , Melissa M Hudson  8 , Leslie L Robison  3 , Juan Carlos Plana  9
Affiliations

Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer: Results From the St. Jude Lifetime Cohort Study

Gregory T Armstrong et al. J Am Coll Cardiol. .

Abstract

Background: Treatment-related cardiac death is the primary, noncancer cause of mortality in adult survivors of childhood malignancies. Early detection of cardiac dysfunction may identify a high-risk subset of survivors for early intervention.

Objectives: This study sought to determine the prevalence of cardiac dysfunction in adult survivors of childhood malignancies.

Methods: Echocardiographic assessment included 3-dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential myocardial strain, and diastolic function, graded per American Society of Echocardiography guidelines in 1,820 adult (median age 31 years; range: 18 to 65 years) survivors of childhood cancer (median time from diagnosis 23 years; range: 10 to 48 years) exposed to anthracycline chemotherapy (n = 1,050), chest-directed radiotherapy (n = 306), or both (n = 464).

Results: Only 5.8% of survivors had abnormal 3D LVEFs (<50%). However, 32.1% of survivors with normal 3D LVEFs had evidence of cardiac dysfunction by global longitudinal strain (28%), American Society of Echocardiography-graded diastolic assessment (8.7%), or both. Abnormal global longitudinal strain was associated with chest-directed radiotherapy at 1 to 19.9 Gy (rate ratio [RR]: 1.38; 95% confidence interval [CI]: 1.14 to 1.66), 20 to 29.9 Gy (RR: 1.65; 95% CI: 1.31 to 2.08), and >30 Gy (RR: 2.39; 95% CI: 1.79 to 3.18) and anthracycline dose > 300 mg/m(2) (RR: 1.72; 95% CI: 1.31 to 2.26). Survivors with metabolic syndrome were twice as likely to have abnormal global longitudinal strain (RR: 1.94; 95% CI: 1.66 to 2.28) and abnormal diastolic function (RR: 1.68; 95% CI: 1.39 to 2.03) but not abnormal 3D LVEFs (RR: 1.07; 95% CI: 0.74 to 1.53).

Conclusions: Abnormal global longitudinal strain and diastolic function are more prevalent than reduced 3D LVEF and are associated with treatment exposure. They may identify a subset of survivors at higher risk for poor clinical cardiac outcomes who may benefit from early medical intervention.

Keywords: cardiomyopathy; cardiotoxicity; heart failure; late effects; screening; strain.

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Figures

Figure1
Figure1
Consort diagram of SJLIFE population eligible for echocardiography evaluation
Figure 2
Figure 2
Prevalence of Cardiac Dysfunction and Reduced Exercise Capacity in Adult, Ten Year Survivors of Childhood Cancer
See this image and copyright information in PMC

Comment in

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