Assessment of global longitudinal strain in pediatric survivors of childhood cancer who received cardiotoxic chemotherapy

Abstract

Cardiotoxicity induced by chemotherapy is the cause of long-term morbidity and mortality, particularly with child exposure. Early detection is essential, as clinical signs are often delayed. In adults, the global longitudinal strain has proven its effectiveness as an early marker of cardiac dysfunction but its place in paediatric management is not yet established. The aim of our study was to analyse the echocardiographic parameters of cardiac function including global longitudinal strain (GLS) in asymptomatic children who received cardiotoxic chemotherapy, at the University Hospital of Amiens, from April to November 2020. The included cases were compared to healthy controls more than one year after their last exposure. We included 22 pediatric childhood cancer survivors and 27 controls with comparable characteristics. The cases had a median age of 11.5 [9.5] years, a median of 3 [1] years from the chemotherapy and a median cumulative anthracycline dose of 234.77 (±105.88) mg/m 2 . Almost a third of our patients were classified as high risk according to CCSS Cardiovascular Risk Calculator score. All myocardial function values were within normal limits. Standard echocardiographic parameters were not different between cases and controls, respectively EF (%) 66.29 (±5.04) vs. 68.14 (±5.37) P < 0.22. As well, Strain 2D values were not significantly different (GLS (%) −20.10 (±2.59) vs. −19.80 (±2.34) P = 0.67). Furthermore, the interobserver reproducibility of GLS was good (intra-class correlation coefficient 0.82 (0.62;0.92) P < 0.01) ( Fig. 1 ). There was no difference of cardiac function echocardiographic parameters, between children who received chemotherapy and controls. There are several limitations, such as the limited number of patients, the monocentric trial and the exclusion of symptomatic patients. The results seem to be in favour of a long free interval between exposure and the onset of altered echocardiographic parameters. Further studies are needed to develop individualised prognostic tools for the follow-up of these patients.