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Echocardiographic Assessment of Cardiac Function in Pediatric Survivors of Anthracycline-Treated Childhood Cancer.
Circulation: Cardiovascular Imaging ( IF 7.5 ) Pub Date : 2019-12-12 , DOI: 10.1161/circimaging.119.008869
Martijn G Slieker 1 , Cheryl Fackoury 1 , Cameron Slorach 1 , Wei Hui 1 , Mark K Friedberg 1 , Chun-Po Steve Fan 1 , Cedric Manlhiot 1 , Rejane Dillenburg 2 , Paul Kantor 3 , Seema Mital 1 , Peter Liu 4 , Paul C Nathan 5 , Luc Mertens 1
Affiliation  

Background:Anthracycline-induced cardiotoxicity is a major cause of morbidity and mortality in childhood cancer survivors (CCSs). Echocardiographic myocardial strain imaging is recommended in adult patients with cancer, but its role in pediatric CCSs has not been well established. Aims of this study were to determine the prevalence of abnormalities in left ventricular strain in pediatric CCSs, to compare strain with other echocardiographic measurements and blood biomarkers, and to explore risk factors for reduced strain.Methods:CCSs ≥3 years from their last anthracycline treatment were enrolled in this multicenter study and underwent a standardized functional echocardiogram and biomarker collection. Regression analysis was used to identify factors associated with longitudinal strain (LS).Results:Five hundred forty-six pediatric CCSs were compared with 134 healthy controls. Abnormal left ventricular ejection fraction (<50%) and mean LS (Z score, <−2) was found in 0.8% and 7.7% of the CCSs, respectively. LS was significantly lower in CCSs than in controls, but the absolute difference was small (0.7%). Lower LS in CCSs was associated with older current age and higher body surface area. Sex, cumulative anthracycline dose, radiotherapy, and biomarkers were not independently associated with LS. Circumferential strain, diastolic parameters, and biomarkers were not significantly different in pediatric CCSs.Conclusions:Global systolic function and LS are only mildly reduced in pediatric CCSs, and most LS values are within normal range. This makes single LS measurements of limited added value in identifying CCSs at risk for cardiac dysfunction. The utility of strain imaging in the long-term follow-up of CCS remains to be demonstrated.

中文翻译:

超声心动图评估蒽环类药物治疗的儿童癌症小儿幸存者的心脏功能。

背景:蒽环类药物引起的心脏毒性是儿童癌症幸存者(CCS)发病率和死亡率的主要原因。在患有癌症的成年患者中,建议使用超声心动图心肌应变成像,但其在小儿CCS中的作用尚不明确。这项研究的目的是确定小儿CCSs左心室应变的患病率,将其与其他超声心动图测量结果和血液生物标志物进行比较,并探讨降低应变的危险因素。方法:距上次蒽环类药物治疗≥3年的CCSs参加了这项多中心研究,并接受了标准化的功能性超声心动图和生物标志物的收集。回归分析用于确定与纵向应变(LS)相关的因素。将546例儿科CCS与134例健康对照进行了比较。左心室射血分数异常(<50%)和平均LS(Z分数<-2)分别在CCS中占0.8%和7.7%。CCS中的LS显着低于对照组,但绝对差异很小(0.7%)。CCSs的LS降低与当前年龄的增加和体表面积的增加有关。性别,蒽环类药物的累积剂量,放疗和生物标志物与LS无关。结论:小儿CCSs的整体收缩功能和LS仅轻度降低,多数LS值均在正常范围内。这使得在确定存在心脏功能障碍风险的CCS时,单次LS测量的附加值有限。应变成像在CCS长期随访中的效用仍有待证明。
更新日期:2019-12-13
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