Dataset Information

Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer: Results From the St. Jude Lifetime Cohort Study.

ABSTRACT:

Background

Treatment-related cardiac death is the primary, noncancer cause of mortality in adult survivors of childhood malignancies. Early detection of cardiac dysfunction may identify a high-risk subset of survivors for early intervention.

Objectives

This study sought to determine the prevalence of cardiac dysfunction in adult survivors of childhood malignancies.

Methods

Echocardiographic assessment included 3-dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential myocardial strain, and diastolic function, graded per American Society of Echocardiography guidelines in 1,820 adult (median age 31 years; range: 18 to 65 years) survivors of childhood cancer (median time from diagnosis 23 years; range: 10 to 48 years) exposed to anthracycline chemotherapy (n = 1,050), chest-directed radiotherapy (n = 306), or both (n = 464).

Results

Only 5.8% of survivors had abnormal 3D LVEFs (<50%). However, 32.1% of survivors with normal 3D LVEFs had evidence of cardiac dysfunction by global longitudinal strain (28%), American Society of Echocardiography-graded diastolic assessment (8.7%), or both. Abnormal global longitudinal strain was associated with chest-directed radiotherapy at 1 to 19.9 Gy (rate ratio [RR]: 1.38; 95% confidence interval [CI]: 1.14 to 1.66), 20 to 29.9 Gy (RR: 1.65; 95% CI: 1.31 to 2.08), and >30 Gy (RR: 2.39; 95% CI: 1.79 to 3.18) and anthracycline dose > 300 mg/m(2) (RR: 1.72; 95% CI: 1.31 to 2.26). Survivors with metabolic syndrome were twice as likely to have abnormal global longitudinal strain (RR: 1.94; 95% CI: 1.66 to 2.28) and abnormal diastolic function (RR: 1.68; 95% CI: 1.39 to 2.03) but not abnormal 3D LVEFs (RR: 1.07; 95% CI: 0.74 to 1.53).

Conclusions

Abnormal global longitudinal strain and 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 outcomes who may benefit from early medical intervention.

SUBMITTER: Armstrong GT

PROVIDER: S-EPMC4539123 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Publications

Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer: Results From the St. Jude Lifetime Cohort Study.

Armstrong Gregory T GT Joshi Vijaya M VM Ness Kirsten K KK Marwick Thomas H TH Zhang Nan N Srivastava DeoKumar D Griffin Brian P BP Grimm Richard A RA Thomas James J Phelan Dermot D Collier Patrick P Krull Kevin R KR Mulrooney Daniel A DA Green Daniel M DM Hudson Melissa M MM Robison Leslie L LL Plana Juan Carlos JC

Journal of the American College of Cardiology 20150601 23

<h4>Background</h4>Treatment-related cardiac death is the primary, noncancer cause of mortality in adult survivors of childhood malignancies. Early detection of cardiac dysfunction may identify a high-risk subset of survivors for early intervention.<h4>Objectives</h4>This study sought to determine the prevalence of cardiac dysfunction in adult survivors of childhood malignancies.<h4>Methods</h4>Echocardiographic assessment included 3-dimensional (3D) left ventricular ejection fraction (LVEF), gl ...[more]

PMID: 26065990

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Dataset Information

Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer: Results From the St. Jude Lifetime Cohort Study.

Background

Objectives

Methods

Results

Conclusions

Publications

Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer: Results From the St. Jude Lifetime Cohort Study.

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