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Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer

Open access
Armstrong, Gregory T., Joshi, Vijaya M., Ness, Kirsten K., Marwick, Thomas H., Zhang, Nan, Srivastava, DeoKumar, Griffin, Brian P., Grimm, Richard A., Thomas, James, Phelan, Dermot, Collier, Patrick, Krull, Kevin R., Mulrooney, Daniel A., Green, Daniel M., Hudson, Melissa M., Robison, Leslie L., Plana, Juan Carlos·2015·Journal of the American College of Cardiology

Abstract

Background Treatment-related cardiac death is the primary non-cancer cause of mortality in adult survivors of childhood malignancies. Early detection of cardiac dysfunction using modern echocardiographic techniques may identify a high risk subset of survivors for early intervention. Objective To determine the prevalence of cardiac dysfunction in adult survivors of childhood malignancies using state of the art echocardiographic evaluation of cardiac function including strain imaging Methods Echocardiographic assessment included three dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential myocardial strain and diastolic function, graded per American Society of Echocardiography (ASE) guidelines on 1,820 adult (median age 31 [range 18-65] years) survivors of childhood cancer (median time from diagnosis 23 years [range10-48] years) exposed to either anthracycline chemotherapy (N=1,050), chest-directed radiotherapy (RT, N=306), or both therapies (N=464). Results Only 5.8% of survivors had an abnormal 3D LVEF (<50%). However, 32.1% of survivors with a normal 3D LVEF had evidence for cardiac dysfunction by either global longitudinal strain (28.0%), ASE graded diastolic assessment (8.7%), or both. Abnormal global longitudinal strain was associated with chest-directed RT (1-19.9 Gy, Rate Ratio (RR) 1.38, 95% Confidence Interval (CI) 1.14-1.66; 20-29.9 Gy, RR 1.65, 95% CI 1.31-2.08; >30 Gy, RR 2.39, 95% CI 1.79-3.18) and anthracycline dose >300 mg/m2 (RR 1.72, 95% CI 1.31-2.26). Survivors with metabolic syndrome were twice as likely to have abnormal global longitudinal strain (Rate Ratio [RR] 1.94, 95% CI 1.66-2.28) as well as abnormal diastolic function (RR 1.68, 95% CI 1.39-2.03), but not abnormal 3D LVEF (RR 1.07, 95% CI 0.74-1.53). Conclusions and Relevance Abnormal global longitudinal strain and abnormal diastolic function are more prevalent than reduced 3D LVEF and are associated with treatment exposure. They may identify a subset of survivors at higher risk for poor clinical cardiac outcome who may benefit from early medical intervention.

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Metadata

Authors
Armstrong, G. T., Joshi, V. M., Ness, K. K., Marwick, T. H., Zhang, N., Srivastava, D., Griffin, B. P., Grimm, R. A., Thomas, J., Phelan, D., Collier, P., Krull, K. R., Mulrooney, D. A., Green, D. M., Hudson, M. M., Robison, L. L., & Plana, J. C.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2015-06
Volume
65
Issue
23
Pages
2511-2522
ISSN
0735-1097 (ISSN-L)
OpenAlex
W1736794870
Cited by
303
References
50
FWCI
18.29
Type
journal article
Language
en
Open access
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Armstrong, G. T., Joshi, V. M., Ness, K. K., Marwick, T. H., Zhang, N., Srivastava, D., Griffin, B. P., Grimm, R. A., Thomas, J., Phelan, D., Collier, P., Krull, K. R., Mulrooney, D. A., Green, D. M., Hudson, M. M., Robison, L. L., & Plana, J. C. (2015). Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer. Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2015.04.013

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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