Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement
In echocardiographic surveillance of anthracycline-treated childhood cancer survivors (CCS), left ventricular ejection fraction (LVEF) has insufficient prognostic value for future cardiac events, whereas longitudinal strain may be more sensitive. We describe the long-term incidence of cardiac events...
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MDPI AG
2022-03-01
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| Series: | Life |
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| Online Access: | https://www.mdpi.com/2075-1729/12/3/452 |
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| author | Milanthy Pourier Remy Merkx Jacqueline Loonen Alyssa van Cleef Chris de Korte Louise Bellersen Livia Kapusta Annelies Mavinkurve-Groothuis |
| author_facet | Milanthy Pourier Remy Merkx Jacqueline Loonen Alyssa van Cleef Chris de Korte Louise Bellersen Livia Kapusta Annelies Mavinkurve-Groothuis |
| author_sort | Milanthy Pourier |
| collection | DOAJ |
| description | In echocardiographic surveillance of anthracycline-treated childhood cancer survivors (CCS), left ventricular ejection fraction (LVEF) has insufficient prognostic value for future cardiac events, whereas longitudinal strain may be more sensitive. We describe the long-term incidence of cardiac events in CCS after previous measurement of LVEF and myocardial strain. Echocardiography, including four-chamber view longitudinal strain (4CH-LS), of 116 anthracycline-treated CCS was obtained between 2005–2009 (index echocardiography). Follow-up was obtained at the late-effects clinic. Primary outcome was occurrence of cardiac events, defined as either symptomatic heart failure, life-threatening arrhythmias, LVEF < 40% or cardiac death, in CCS with normal versus abnormal index 4CH-LS. LVEF from subsequent echocardiograms was obtained to evaluate its natural course as a secondary outcome. After index echocardiography (median 13.1 years since childhood cancer diagnosis), our study added a median follow-up of 11.3 years (median last clinical contact 23.6 years since diagnosis). Only three CCS developed a cardiac event (6.2, 6.4 and 6.7 years after index echocardiography), resulting in a ten-year cumulative incidence of 2.7% (95%CI 0.9–8.2). All three CCS had a clearly reduced index 4CH-LS and relevant cardiovascular risk factors, whereas their index LVEFs were around the lower limit of normal. Index LVEF correlated with index 4CH-LS but mean long-term natural course of LVEF was comparable for CCS with abnormal versus normal index 4CH-LS. Absolute 10-year cumulative incidence of cardiac events in anthracycline-treated CCS during long-term follow-up was low. Sensitive echocardiographic measurements, such as 4CH-LS may be useful to tailor surveillance frequency in a selected group of CCS without cardiovascular disease. |
| first_indexed | 2024-03-09T13:33:43Z |
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| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-09T13:33:43Z |
| publishDate | 2022-03-01 |
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| record_format | Article |
| series | Life |
| spelling | doaj.art-00098f2c70154dcbb0af14ba836804fa2023-11-30T21:14:55ZengMDPI AGLife2075-17292022-03-0112345210.3390/life12030452Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain MeasurementMilanthy Pourier0Remy Merkx1Jacqueline Loonen2Alyssa van Cleef3Chris de Korte4Louise Bellersen5Livia Kapusta6Annelies Mavinkurve-Groothuis7Department of Pediatrics Amalia Children’s Hospital, Radboud University Medical Center, 6500 HB Nijmegen, The NetherlandsDepartment of Medical Imaging, Radboud University Medical Center, 6500 HB Nijmegen, The NetherlandsDepartment of Hematology, Radboud University Medical Center, 6500 HB Nijmegen, The NetherlandsDepartment of Hematology, Radboud University Medical Center, 6500 HB Nijmegen, The NetherlandsDepartment of Medical Imaging, Radboud University Medical Center, 6500 HB Nijmegen, The NetherlandsDepartment of Cardiology, Radboud University Medical Center, 6500 HB Nijmegen, The NetherlandsPediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, IsraelPrincess Máxima Center for Pediatric Oncology, 3720 AC Utrecht, The NetherlandsIn echocardiographic surveillance of anthracycline-treated childhood cancer survivors (CCS), left ventricular ejection fraction (LVEF) has insufficient prognostic value for future cardiac events, whereas longitudinal strain may be more sensitive. We describe the long-term incidence of cardiac events in CCS after previous measurement of LVEF and myocardial strain. Echocardiography, including four-chamber view longitudinal strain (4CH-LS), of 116 anthracycline-treated CCS was obtained between 2005–2009 (index echocardiography). Follow-up was obtained at the late-effects clinic. Primary outcome was occurrence of cardiac events, defined as either symptomatic heart failure, life-threatening arrhythmias, LVEF < 40% or cardiac death, in CCS with normal versus abnormal index 4CH-LS. LVEF from subsequent echocardiograms was obtained to evaluate its natural course as a secondary outcome. After index echocardiography (median 13.1 years since childhood cancer diagnosis), our study added a median follow-up of 11.3 years (median last clinical contact 23.6 years since diagnosis). Only three CCS developed a cardiac event (6.2, 6.4 and 6.7 years after index echocardiography), resulting in a ten-year cumulative incidence of 2.7% (95%CI 0.9–8.2). All three CCS had a clearly reduced index 4CH-LS and relevant cardiovascular risk factors, whereas their index LVEFs were around the lower limit of normal. Index LVEF correlated with index 4CH-LS but mean long-term natural course of LVEF was comparable for CCS with abnormal versus normal index 4CH-LS. Absolute 10-year cumulative incidence of cardiac events in anthracycline-treated CCS during long-term follow-up was low. Sensitive echocardiographic measurements, such as 4CH-LS may be useful to tailor surveillance frequency in a selected group of CCS without cardiovascular disease.https://www.mdpi.com/2075-1729/12/3/452cardiotoxicitystrain imaginganthracyclinescardiac eventheart failurechildhood cancer survivors |
| spellingShingle | Milanthy Pourier Remy Merkx Jacqueline Loonen Alyssa van Cleef Chris de Korte Louise Bellersen Livia Kapusta Annelies Mavinkurve-Groothuis Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement Life cardiotoxicity strain imaging anthracyclines cardiac event heart failure childhood cancer survivors |
| title | Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement |
| title_full | Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement |
| title_fullStr | Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement |
| title_full_unstemmed | Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement |
| title_short | Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement |
| title_sort | cardiac events in childhood cancer survivors treated with anthracyclines the value of previous myocardial strain measurement |
| topic | cardiotoxicity strain imaging anthracyclines cardiac event heart failure childhood cancer survivors |
| url | https://www.mdpi.com/2075-1729/12/3/452 |
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