TY - JOUR
T1 - Dynamic Myocardial Response to Exercise in Childhood Cancer Survivors Treated with Anthracyclines
AU - Cifra, Barbara
AU - Chen, Ching Kit
AU - Fan, Chun Po S.
AU - Slorach, Cameron
AU - Manlhiot, Cedric
AU - McCrindle, Brian W.
AU - Dragulescu, Andreea
AU - Redington, Andrew N.
AU - Friedberg, Mark K.
AU - Nathan, Paul C.
AU - Mertens, Luc
N1 - Funding Information:
This research study is being conducted with support from the Canadian Institutes of Health Research (TCF118696), the Ontario Institute for Cancer Research, the Children's Cancer and Blood Disorders Council, the Canadian Cancer Society, the Pediatric Oncology Group of Ontario, and the Garron Family Heart Centre at the Hospital for Sick Children.
Funding Information:
This research study is being conducted with support from the Canadian Institutes of Health Research ( TCF118696 ), the Ontario Institute for Cancer Research , the Children's Cancer and Blood Disorders Council, the Canadian Cancer Society , the Pediatric Oncology Group of Ontario , and the Garron Family Heart Centre at the Hospital for Sick Children .
Publisher Copyright:
© 2018 American Society of Echocardiography
PY - 2018/8
Y1 - 2018/8
N2 - Background: Anthracycline cardiotoxicity can cause significant long-term morbidity in childhood cancer survivors (CCS), but many CCS do not manifest clinical symptoms until adulthood. The aims of this study were to characterize the dynamic myocardial response to exercise of CCS at long-term follow-up by combining semisupine bicycle exercise stress echocardiography with myocardial imaging techniques and to establish whether semisupine bicycle exercise stress echocardiography could identify CCS with abnormal exercise response. Methods: This was a single-center prospective cross-sectional study. One hundred CCS and 51 control subjects underwent semisupine bicycle exercise stress echocardiography. Color Doppler tissue imaging peak systolic (s′) and diastolic (e′) velocities, myocardial acceleration during isovolumic contraction, and longitudinal strain were measured at rest and at incremental heart rates in the left ventricular (LV) lateral wall, basal septum, and right ventricle. The relationship with increasing heart rate was evaluated for each parameter by plotting the values against heart rate at each stage of exercise. Kernel density estimate was used to establish the normality of the individual CCS exercise responses. Results: At rest, no significant differences were found for LV lateral wall, right ventricular (RV), and basal septal systolic and diastolic velocities between CCS and control subjects. Only septal e′ was lower in CCS. LV longitudinal strain was similar between groups, while RV longitudinal strain was lower in CCS. At peak exercise, LV lateral wall, RV, and septal s′ were not different between groups, while e′ were significantly lower in CCS. LV lateral wall and septal isovolumic acceleration were also reduced in CCS. LV longitudinal strain was different between groups, while RV longitudinal strain was similar. The dynamic response of Doppler tissue imaging velocities, isovolumic acceleration, and strain was similar between CCS and control subjects. Kernel density estimate analysis confirmed that most CCS responses were within the normal range. Conclusions: At 10-year follow-up, anthracycline-treated CCS with normal baseline ejection fractions have LV and RV systolic and diastolic myocardial exercise response comparable with that of control subjects. Minor differences were observed between CCS and control subjects at rest and at peak exercise, but the dynamic response is within the normal range.
AB - Background: Anthracycline cardiotoxicity can cause significant long-term morbidity in childhood cancer survivors (CCS), but many CCS do not manifest clinical symptoms until adulthood. The aims of this study were to characterize the dynamic myocardial response to exercise of CCS at long-term follow-up by combining semisupine bicycle exercise stress echocardiography with myocardial imaging techniques and to establish whether semisupine bicycle exercise stress echocardiography could identify CCS with abnormal exercise response. Methods: This was a single-center prospective cross-sectional study. One hundred CCS and 51 control subjects underwent semisupine bicycle exercise stress echocardiography. Color Doppler tissue imaging peak systolic (s′) and diastolic (e′) velocities, myocardial acceleration during isovolumic contraction, and longitudinal strain were measured at rest and at incremental heart rates in the left ventricular (LV) lateral wall, basal septum, and right ventricle. The relationship with increasing heart rate was evaluated for each parameter by plotting the values against heart rate at each stage of exercise. Kernel density estimate was used to establish the normality of the individual CCS exercise responses. Results: At rest, no significant differences were found for LV lateral wall, right ventricular (RV), and basal septal systolic and diastolic velocities between CCS and control subjects. Only septal e′ was lower in CCS. LV longitudinal strain was similar between groups, while RV longitudinal strain was lower in CCS. At peak exercise, LV lateral wall, RV, and septal s′ were not different between groups, while e′ were significantly lower in CCS. LV lateral wall and septal isovolumic acceleration were also reduced in CCS. LV longitudinal strain was different between groups, while RV longitudinal strain was similar. The dynamic response of Doppler tissue imaging velocities, isovolumic acceleration, and strain was similar between CCS and control subjects. Kernel density estimate analysis confirmed that most CCS responses were within the normal range. Conclusions: At 10-year follow-up, anthracycline-treated CCS with normal baseline ejection fractions have LV and RV systolic and diastolic myocardial exercise response comparable with that of control subjects. Minor differences were observed between CCS and control subjects at rest and at peak exercise, but the dynamic response is within the normal range.
KW - Anthracycline cardiotoxicity
KW - Children
KW - Strain echocardiography
KW - Stress echocardiography
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U2 - 10.1016/j.echo.2018.02.003
DO - 10.1016/j.echo.2018.02.003
M3 - Article
C2 - 29615292
AN - SCOPUS:85044589124
SN - 0894-7317
VL - 31
SP - 933
EP - 942
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 8
ER -