Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer

Martijn G. Slieker, Cheryl Fackoury, Cameron Slorach, Wei Hui, Mark K. Friedberg, Chun Po Steve Fan, Cedric Manlhiot, Rejane Dillenburg, Paul Kantor, Seema Mital, Peter Liu, Paul C. Nathan, Luc Mertens

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Anthracycline-induced cardiotoxicity is a major cause of morbidity and mortality in childhood cancer survivors (CCSs). Echocardiographic myocardial strain imaging is recommended in adult patients with cancer, but its role in pediatric CCSs has not been well established. Aims of this study were to determine the prevalence of abnormalities in left ventricular strain in pediatric CCSs, to compare strain with other echocardiographic measurements and blood biomarkers, and to explore risk factors for reduced strain. METHODS: CCSs ≥3 years from their last anthracycline treatment were enrolled in this multicenter study and underwent a standardized functional echocardiogram and biomarker collection. Regression analysis was used to identify factors associated with longitudinal strain (LS). RESULTS: Five hundred forty-six pediatric CCSs were compared with 134 healthy controls. Abnormal left ventricular ejection fraction (<50%) and mean LS (Z score, <-2) was found in 0.8% and 7.7% of the CCSs, respectively. LS was significantly lower in CCSs than in controls, but the absolute difference was small (0.7%). Lower LS in CCSs was associated with older current age and higher body surface area. Sex, cumulative anthracycline dose, radiotherapy, and biomarkers were not independently associated with LS. Circumferential strain, diastolic parameters, and biomarkers were not significantly different in pediatric CCSs. CONCLUSIONS: Global systolic function and LS are only mildly reduced in pediatric CCSs, and most LS values are within normal range. This makes single LS measurements of limited added value in identifying CCSs at risk for cardiac dysfunction. The utility of strain imaging in the long-term follow-up of CCS remains to be demonstrated.

Original languageEnglish (US)
Pages (from-to)e008869
JournalCirculation. Cardiovascular imaging
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2019

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Anthracyclines
Survivors
Pediatrics
Neoplasms
Biomarkers
Body Surface Area
Stroke Volume
Multicenter Studies
Reference Values
Radiotherapy
Regression Analysis

Keywords

  • cardiotoxicity
  • child
  • early diagnosi
  • humans
  • ventricular dysfunction, left

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Slieker, M. G., Fackoury, C., Slorach, C., Hui, W., Friedberg, M. K., Fan, C. P. S., ... Mertens, L. (2019). Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer. Circulation. Cardiovascular imaging, 12(12), e008869. https://doi.org/10.1161/CIRCIMAGING.119.008869

Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer. / Slieker, Martijn G.; Fackoury, Cheryl; Slorach, Cameron; Hui, Wei; Friedberg, Mark K.; Fan, Chun Po Steve; Manlhiot, Cedric; Dillenburg, Rejane; Kantor, Paul; Mital, Seema; Liu, Peter; Nathan, Paul C.; Mertens, Luc.

In: Circulation. Cardiovascular imaging, Vol. 12, No. 12, 01.12.2019, p. e008869.

Research output: Contribution to journalArticle

Slieker, MG, Fackoury, C, Slorach, C, Hui, W, Friedberg, MK, Fan, CPS, Manlhiot, C, Dillenburg, R, Kantor, P, Mital, S, Liu, P, Nathan, PC & Mertens, L 2019, 'Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer', Circulation. Cardiovascular imaging, vol. 12, no. 12, pp. e008869. https://doi.org/10.1161/CIRCIMAGING.119.008869
Slieker, Martijn G. ; Fackoury, Cheryl ; Slorach, Cameron ; Hui, Wei ; Friedberg, Mark K. ; Fan, Chun Po Steve ; Manlhiot, Cedric ; Dillenburg, Rejane ; Kantor, Paul ; Mital, Seema ; Liu, Peter ; Nathan, Paul C. ; Mertens, Luc. / Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer. In: Circulation. Cardiovascular imaging. 2019 ; Vol. 12, No. 12. pp. e008869.
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title = "Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer",
abstract = "BACKGROUND: Anthracycline-induced cardiotoxicity is a major cause of morbidity and mortality in childhood cancer survivors (CCSs). Echocardiographic myocardial strain imaging is recommended in adult patients with cancer, but its role in pediatric CCSs has not been well established. Aims of this study were to determine the prevalence of abnormalities in left ventricular strain in pediatric CCSs, to compare strain with other echocardiographic measurements and blood biomarkers, and to explore risk factors for reduced strain. METHODS: CCSs ≥3 years from their last anthracycline treatment were enrolled in this multicenter study and underwent a standardized functional echocardiogram and biomarker collection. Regression analysis was used to identify factors associated with longitudinal strain (LS). RESULTS: Five hundred forty-six pediatric CCSs were compared with 134 healthy controls. Abnormal left ventricular ejection fraction (<50{\%}) and mean LS (Z score, <-2) was found in 0.8{\%} and 7.7{\%} of the CCSs, respectively. LS was significantly lower in CCSs than in controls, but the absolute difference was small (0.7{\%}). Lower LS in CCSs was associated with older current age and higher body surface area. Sex, cumulative anthracycline dose, radiotherapy, and biomarkers were not independently associated with LS. Circumferential strain, diastolic parameters, and biomarkers were not significantly different in pediatric CCSs. CONCLUSIONS: Global systolic function and LS are only mildly reduced in pediatric CCSs, and most LS values are within normal range. This makes single LS measurements of limited added value in identifying CCSs at risk for cardiac dysfunction. The utility of strain imaging in the long-term follow-up of CCS remains to be demonstrated.",
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T1 - Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer

AU - Slieker, Martijn G.

AU - Fackoury, Cheryl

AU - Slorach, Cameron

AU - Hui, Wei

AU - Friedberg, Mark K.

AU - Fan, Chun Po Steve

AU - Manlhiot, Cedric

AU - Dillenburg, Rejane

AU - Kantor, Paul

AU - Mital, Seema

AU - Liu, Peter

AU - Nathan, Paul C.

AU - Mertens, Luc

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Y1 - 2019/12/1

N2 - BACKGROUND: Anthracycline-induced cardiotoxicity is a major cause of morbidity and mortality in childhood cancer survivors (CCSs). Echocardiographic myocardial strain imaging is recommended in adult patients with cancer, but its role in pediatric CCSs has not been well established. Aims of this study were to determine the prevalence of abnormalities in left ventricular strain in pediatric CCSs, to compare strain with other echocardiographic measurements and blood biomarkers, and to explore risk factors for reduced strain. METHODS: CCSs ≥3 years from their last anthracycline treatment were enrolled in this multicenter study and underwent a standardized functional echocardiogram and biomarker collection. Regression analysis was used to identify factors associated with longitudinal strain (LS). RESULTS: Five hundred forty-six pediatric CCSs were compared with 134 healthy controls. Abnormal left ventricular ejection fraction (<50%) and mean LS (Z score, <-2) was found in 0.8% and 7.7% of the CCSs, respectively. LS was significantly lower in CCSs than in controls, but the absolute difference was small (0.7%). Lower LS in CCSs was associated with older current age and higher body surface area. Sex, cumulative anthracycline dose, radiotherapy, and biomarkers were not independently associated with LS. Circumferential strain, diastolic parameters, and biomarkers were not significantly different in pediatric CCSs. CONCLUSIONS: Global systolic function and LS are only mildly reduced in pediatric CCSs, and most LS values are within normal range. This makes single LS measurements of limited added value in identifying CCSs at risk for cardiac dysfunction. The utility of strain imaging in the long-term follow-up of CCS remains to be demonstrated.

AB - BACKGROUND: Anthracycline-induced cardiotoxicity is a major cause of morbidity and mortality in childhood cancer survivors (CCSs). Echocardiographic myocardial strain imaging is recommended in adult patients with cancer, but its role in pediatric CCSs has not been well established. Aims of this study were to determine the prevalence of abnormalities in left ventricular strain in pediatric CCSs, to compare strain with other echocardiographic measurements and blood biomarkers, and to explore risk factors for reduced strain. METHODS: CCSs ≥3 years from their last anthracycline treatment were enrolled in this multicenter study and underwent a standardized functional echocardiogram and biomarker collection. Regression analysis was used to identify factors associated with longitudinal strain (LS). RESULTS: Five hundred forty-six pediatric CCSs were compared with 134 healthy controls. Abnormal left ventricular ejection fraction (<50%) and mean LS (Z score, <-2) was found in 0.8% and 7.7% of the CCSs, respectively. LS was significantly lower in CCSs than in controls, but the absolute difference was small (0.7%). Lower LS in CCSs was associated with older current age and higher body surface area. Sex, cumulative anthracycline dose, radiotherapy, and biomarkers were not independently associated with LS. Circumferential strain, diastolic parameters, and biomarkers were not significantly different in pediatric CCSs. CONCLUSIONS: Global systolic function and LS are only mildly reduced in pediatric CCSs, and most LS values are within normal range. This makes single LS measurements of limited added value in identifying CCSs at risk for cardiac dysfunction. The utility of strain imaging in the long-term follow-up of CCS remains to be demonstrated.

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