Abstract

Anthracycline-induced cardiotoxicity can lead to clinical and subclinical heart failure. Decrease of global longitudinal strain is a predictor for heart failure. Early detection of subclinical cardiotoxicity is crucial for timely intervention and prevention of further progression. Cardiac function of 41 survivors of childhood acute lymphoblastic leukemia (ALL) was assessed. Values of cardiac troponin T, N-terminal-pro-brain natriuretic peptide, conventional and myocardial 2D strain echocardiography were measured before (T = 0), during (T = 1, cumulative dose of 120 mg/m2), shortly after (T = 2) and long after anthracycline treatment (T = 3, ≥5 years after anthracycline exposure). Cardiac function of survivors at the latest follow up was compared with 70 healthy age-matched controls. None of the survivors showed clinical signs of cardiac failure at T = 3. Strain values decreased during anthracycline treatment and an ongoing reduction was seen at the latest follow-up (T = 3) with preserved cardiac function (normal ejection fraction and shortening fraction). At T = 1, a relative reduction in longitudinal strain (≥10% compared with baseline) was observed in 38% of the survivors, which increased to 54% at T=3. ALL survivors showed significantly lower conventional and myocardial 2D strain values, especially strain rate, compared with healthy age-matched controls. At T = 3, we did not find any abnormal cardiac troponin T levels. Six percent of the survivors showed abnormal N-terminal-pro-brain natriuretic peptide levels. This prospective study showed an ongoing reduction of 2D myocardial strain and strain rate, with preserved left ventricular ejection fraction (≤10% decrease compared with baseline) in asymptomatic ALL survivors at late follow-up.

Highlights

  • Shortening fraction (LVSF) lack sensitivity for detection of systolic dysfunction and a significant decrease may be a late finding in cardiotoxicity.[3,4] In the expert consensus for adult patients during and after cancer therapy, global longitudinal strain (GLS) has shown to be the single best parameter to predict anthracycline-induced cardiotoxicity, as a decrease of 10% to 15% of this parameter is often seen before a relevant reduction of LVEF is observed.[2,3] Cardiac biomarkers N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin T are widely used for detection of cardiac injury in both adults and children

  • In this study we investigate ongoing subclinical cardiotoxicity at late follow-up in previously reported patients with childhood acute lymphoblastic leukemia (ALL)[5] using conventional and myocardial strain echocardiographic parameters and measuring biomarkers

  • This study addresses the role of strain echocardiography in evaluating subclinical cardiotoxicity in childhood cancer survivors (CCS) by providing prospective longitudinal echocardiographic assessment from start of therapy to late follow-up, including strain

Read more

Summary

Introduction

Shortening fraction (LVSF) lack sensitivity for detection of systolic dysfunction and a significant decrease may be a late finding in cardiotoxicity.[3,4] In the expert consensus for adult patients during and after cancer therapy, global longitudinal strain (GLS) has shown to be the single best parameter to predict anthracycline-induced cardiotoxicity, as a decrease of 10% to 15% of this parameter is often seen before a relevant reduction of LVEF is observed.[2,3] Cardiac biomarkers N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin T (cTnT) are widely used for detection of cardiac injury (e.g. cardiac ischemia and heart failure) in both adults and children. In this study we investigate ongoing subclinical cardiotoxicity at late follow-up in previously reported patients with childhood acute lymphoblastic leukemia (ALL)[5] using conventional and myocardial strain echocardiographic parameters and measuring biomarkers. We compared cardiac function of ALL survivors at late followup to healthy age-matched controls

Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call