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Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography

Published online by Cambridge University Press:  27 November 2019

Jyothsna Akam-Venkata*
Affiliation:
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
Gilda Kadiu
Affiliation:
Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
James Galas
Affiliation:
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
Steven E. Lipshultz
Affiliation:
Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children’s Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Sanjeev Aggarwal
Affiliation:
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
*
Author for correspondence: J. Akam-Venkata, Division of Cardiology, Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA. Tel: +1-313-268-8942; Fax: +1-313-993-0894. E-mail: jyothsnaav@gmail.com

Abstract

Aim:

Anthracycline-associated cardiotoxicity in childhood cancer survivors may relate to global or segmental left ventricular abnormalities from associated thromboembolic events and myocardial microinfarcts. We characterized left ventricular segmental changes by two-dimensional speckle-tracking echocardiography in anthracycline-treated asymptomatic childhood cancer survivors.

Methods and Results:

Childhood cancer survivors’ echocardiograms with normal left ventricular fractional shortening >1 year after anthracycline chemotherapy were studied. Cancer-free control children had normal echocardiograms. Apical two-, three-, and four-chamber peak systolic left ventricular longitudinal and global longitudinal strain, and peak systolic left ventricular radial and circumferential strain at papillary muscle levels were analyzed. The mean (standard deviation) age was 12.7 (3.8) years in 41 childhood cancer survivors. The median (interquartile range) follow-up after anthracycline chemotherapy was 4.73 (2.15–8) years. The median (range) cumulative anthracycline dose was 160.2 (60–396.9) mg/m2. In childhood cancer survivors, the mean (standard deviation) left ventricular longitudinal strain was lower in two- (−18.6 [3.2] versus −21.3 [2.5], p < 0.001), three- (−16.3 [6.0] versus −21.7 [3.0], p < 0.001), and four- (−17.6 [2.7] versus −20.8 [2.0], p < 0.001) chamber views compared to controls. The left ventricular global longitudinal strain (−17.6 [2.7] versus −21.3 [2.0]) and circumferential strain (−20.8 [4.3] versus −23.5 [2.6], p < 0.001) were lower in childhood cancer survivors. Among childhood cancer survivors, 12 out of 16 left ventricular segments had significantly lower longitudinal strain than controls.

Conclusions:

Asymptomatic anthracycline-treated childhood cancer survivors with normal left ventricular fractional shortening had lower global longitudinal and circumferential strain. The left ventricular longitudinal strain was lower in majority of the segments, suggesting that anthracycline cardiotoxicity is more global than regional.

Type
Original Article
Copyright
© Cambridge University Press 2019 

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