Abstract 14988: Longitudinal Strain for Early Identification of Anthracycline-Induced Cardiomyopathy in Pediatrics

Abstract

Introduction: Anthracycline-induced cardiomyopathy (ACM) affects pediatric cancer survivors and echocardiogram (echo) surveillance is required. In adults, a decline in global longitudinal strain (LS) >15% is a pre-clinical marker of ACM. There is utility in determining change in strain associated with pre-clinical ACM in pediatrics. Methods: We queried our institutional database to identify patients <19 yo, with acute myeloid leukemia (AML), Ewing’s sarcoma or osteosarcoma, who received anthracyclines (1/1/2008 - 12/31/2020), and developed sub-acute or chronic ACM (LVEF <55% greater than 30 days post anthracycline completion). Echo at baseline (time of cancer diagnosis) and pre-ACM (within 2 years of first documented LVEF <55%) were compared for strain differences. Four-chamber LS, mid-chamber circumferential strain (CS) and left atrial strain (LAS) were analyzed using TomTec software. Results: Twenty-two patients were eligible for analysis from 428 meeting inclusion criteria (Figure 1). Demographics are shown in Table 1. There was a significant decline in LS from baseline to pre-ACM echo (-20.7 +/-2.98 vs -18.2 +/-3.74; p=0.026) amounting to a mean absolute LS decline of 2.5% and relative decline of 12.4% from baseline. Differences in CS (25.15 +/-4.89 vs 23.44 +/-5.11; p=0.35), LAS (43.09 +/-10.48 vs 45.23 +/-13.43; p=0.54) and heart rate (99.55 +/-19.88 vs 90.24 +/-26.47; p=0.09) were not significant. Conclusions: A significant decrease in LS occurs following anthracyclines pre-dating the diagnosis of subacute or chronic ACM in children. Prospective research with established imaging protocols may validate the role of strain in surveillance for pediatric ACM.