Abstract
BackgroundIn childhood cancer survivors (CCSs) anthracycline-related cardiotoxicity is an important cause of morbidity and late mortality, but the optimal modality of cardiac surveillance still remains to be defined. The aim of this study was to assess whether non-invasive echocardiography-based functional cardiac measures can detect early subclinical myocardial changes in long-term pediatric cancer survivors who received anthracycline therapy.MethodsTwenty anthracycline-treated long-term CCSs and 20 age, sex, and body surface area matched healthy controls were enrolled in this study. Among cancer survivors, mean age at diagnosis was 6.5 ± 4.4 years, and the mean cumulative anthracycline dose was 234.5 ± 87.4 mg/m2. All subjects underwent a comprehensive functional echocardiographic protocol study including two-dimensional echocardiography (2D Echo), tissue Doppler imaging (TDI), speckle tracking (STE) and three-dimensional echocardiography (3D Echo). Patients were studied at a mean follow-up time of 6.5 ± 2.8 years from the end of therapy.ResultsNo significant differences in two-dimensional left ventricle ejection fraction (LVEF), diastolic parameters and speckle tracking (STE)-derived myocardial strain were observed between patients treated with anthracyclines and controls. Myocardial performance index was significantly prolonged (p = 0.005) and three-dimensional LVEF was significantly reduced (p = 0.002) in CCSs compared to controls, even though most values were within the normal range. There were no significant correlations between 2D, STE, and 3D echocardiographic parameters and age at diagnosis or duration of follow-up. No significant differences in echocardiographic parameters were found when stratifying cancer patients according to established risk factors for anthracycline cardiomyopathy.ConclusionsThis study found significantly reduced three-dimensional LVEF in CCSs compared with controls, despite no significant differences in two-dimensional LVEF and longitudinal strain values. These findings suggest that long-term CCSs who had received anthracycline therapy may be found to have subclinical features of myocardial dysfunction. However, further studies are needed to demonstrate the validity of new imaging techniques, including STE and 3D Echo, to identify patients at risk for cardiomyopathy in the long-term follow-up of CCSs.
Highlights
Advances in treatment strategies for childhood cancer have resulted in a significant improvement in survival [1, 2], but there is growing concern about the long-term side effects of therapy [3, 4]
We evaluated three-dimensional Left ventricle (LV) volumes and LVEF. 3D Echo is a novel echocardiographic technology that is based on the acquisition of “volumes” containing heart structures. 3D measurements of volumes and LVEF have been proved to be more accurate and reproducible compared to standard 2D Echo and similar to those obtained with cardiac magnetic resonance (CMR) [17, 18]
Our current study demonstrated significantly decreased LV shortening fraction (LVSF) in cancer survivors s (CCSs) compared to healthy controls (p = 0.027), but no significant difference in LVEF, with all CCSs having LVSF and LVEF values within the normal range
Summary
Advances in treatment strategies for childhood cancer have resulted in a significant improvement in survival [1, 2], but there is growing concern about the long-term side effects of therapy [3, 4]. Left ventricle (LV) dysfunction and heart failure (HF) are the most concerning cardiovascular complications of cancer therapies and could increasingly become a main cause of morbidity and death of childhood cancer survivors s (CCSs) [7, 8]. The early detection of cardiotoxicity is often challenging, due to a long subclinical phase of LV dysfunction; an early diagnosis of cardiovascular disease in these patients would be crucial as it could allow a timely initiation of cardioprotective therapies that might delay myocardial remodeling and prevent LV cardiomyopathy. In childhood cancer survivors (CCSs) anthracycline-related cardiotoxicity is an important cause of morbidity and late mortality, but the optimal modality of cardiac surveillance still remains to be defined. The aim of this study was to assess whether noninvasive echocardiography-based functional cardiac measures can detect early subclinical myocardial changes in long-term pediatric cancer survivors who received anthracycline therapy
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