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

被引:225
作者
Armstrong, Gregory T. [1 ]
Joshi, Vijaya M. [2 ]
Ness, Kirsten K. [1 ]
Marwick, Thomas H. [3 ]
Zhang, Nan [4 ]
Srivastava, DeoKumar [4 ]
Griffin, Brian P. [5 ]
Grimm, Richard A. [5 ]
Thomas, James [6 ]
Phelan, Dermot [5 ]
Collier, Patrick [5 ]
Krull, Kevin R. [1 ]
Mulrooney, Daniel A. [7 ]
Green, Daniel M. [1 ]
Hudson, Melissa M. [7 ]
Robison, Leslie L. [1 ]
Plana, Juan Carlos [8 ]
机构
[1] St Jude Childrens Res Hosp, Dept Epidemiol & Canc Control, Memphis, TN 38105 USA
[2] Univ Tennessee, Ctr Hlth Sci, Dept Pediat, Memphis, TN 38163 USA
[3] Univ Tasmania, Menzies Res Inst, Hobart, Tas, Australia
[4] St Jude Childrens Res Hosp, Dept Biostat, Memphis, TN 38105 USA
[5] Cleveland Clin, Dept Cardiovasc Med, Cleveland, OH 44106 USA
[6] NW Mem Hosp, Bluhm Cardiovasc Inst, Chicago, IL 60611 USA
[7] St Jude Childrens Res Hosp, Dept Oncol, Memphis, TN 38105 USA
[8] Baylor Coll Med, Houston, TX 77030 USA
关键词
cardiomyopathy; cardiotoxicity; heart failure; late effects; screening; strain; VENTRICULAR EJECTION FRACTION; CARDIOVASCULAR RISK-FACTORS; SPECKLE-TRACKING; EUROPEAN-ASSOCIATION; AMERICAN-SOCIETY; DIASTOLIC DYSFUNCTION; 2-DIMENSIONAL STRAIN; 5-YEAR SURVIVORS; EXPERT CONSENSUS; HEART-FAILURE;
D O I
10.1016/j.jacc.2015.04.013
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. (C) 2015 by the American College of Cardiology Foundation.
引用
收藏
页码:2511 / 2522
页数:12
相关论文
共 51 条
  • [21] Frequency and risk factors of anthracycline-induced clinical heart failure in children:: a systematic review
    Kremer, LCM
    van Dalen, EC
    Offringa, M
    Voûte, PA
    [J]. ANNALS OF ONCOLOGY, 2002, 13 (04) : 503 - 512
  • [22] Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography
    Lancellotti, Patrizio
    Nkomo, Vuyisile T.
    Badano, Luigi P.
    Bergler, Jutta
    Bogaert, Jan
    Davin, Laurent
    Cosyns, Bernard
    Coucke, Philippe
    Dulgheru, Raluca
    Edvardsen, Thor
    Gaemperli, Oliver
    Galderisi, Maurizio
    Griffin, Brian
    Heidenreich, Paul A.
    Nieman, Koen
    Plana, Juan C.
    Port, Steven C.
    Scherrer-Crosbie, Marielle
    Schwartz, Ronald G.
    Sebag, Igal A.
    Voigt, Jens-Uwe
    Wann, Samuel
    Yang, Phillip C.
    [J]. EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING, 2013, 14 (08) : 721 - 740
  • [23] Recommendations for chamber quantification: A report from the American Society of Echocardiography's guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
    Lang, RM
    Bierig, M
    Devereux, RB
    Flachskampf, FA
    Foster, E
    Pellikka, PA
    Picard, MH
    Roman, MJ
    Seward, J
    Shanewise, JS
    Solomon, SD
    Spencer, KT
    Sutton, MS
    Stewart, WJ
    [J]. JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2005, 18 (12) : 1440 - 1463
  • [24] Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions A Scientific Statement From the American Heart Association
    Lipshultz, Steven E.
    Adams, Jacob
    Colan, Steven D.
    Constine, Louis S.
    Herman, Eugene H.
    Hsu, Daphne T.
    Hudson, Melissa M.
    Kremer, Leontien C.
    Landy, David C.
    Miller, Tracie L.
    Oeffinger, Kevin C.
    Rosenthal, David N.
    Sable, Craig A.
    Sallan, Stephen E.
    Singh, Gautam K.
    Steinberger, Julia
    Cochran, Thomas R.
    Wilkinson, James D.
    [J]. CIRCULATION, 2013, 128 (17) : 1927 - 1995
  • [25] MYOCARDIAL STRAIN AND STRAIN RATE IN MONITORING SUBCLINICAL HEART FAILURE IN ASYMPTOMATIC LONG-TERM SURVIVORS OF CHILDHOOD CANCER
    Maninkurve-Groothuis, Annelies M. C.
    Groot-Loonen, Jacqueline
    Marcus, Karen A.
    Bellersen, Louise
    Feuth, Ton
    Bokkerink, Jos P. M.
    Hoogerbrugge, Peter M.
    de Korte, Chris
    Kapusta, Livia
    [J]. ULTRASOUND IN MEDICINE AND BIOLOGY, 2010, 36 (11) : 1783 - 1791
  • [26] Myocardial Strain Measurement With 2-Dimensional Speckle-Tracking Echocardiography Definition of Normal Range
    Marwick, Thomas H.
    Leano, Rodel L.
    Brown, Joseph
    Sun, Jing-Ping
    Hoffmann, Rainer
    Lysyansky, Peter
    Becker, Michael
    Thomas, James D.
    [J]. JACC-CARDIOVASCULAR IMAGING, 2009, 2 (01) : 80 - 84
  • [27] Cause-specific late mortality among 5-year survivors of childhood cancer: The childhood cancer survivor study
    Mertens, Ann C.
    Liu, Qi
    Neglia, Joseph P.
    Wasilewski, Karen
    Leisenring, Wendy
    Armstrong, Gregory T.
    Robison, Leslie L.
    Yasui, Yutaka
    [J]. JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2008, 100 (19): : 1368 - 1379
  • [28] Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort
    Mulrooney, Daniel A.
    Yeazel, Mark W.
    Kawashima, Toana
    Mertens, Ann C.
    Mitby, Pauline
    Stovall, Marilyn
    Donaldson, Sarah S.
    Green, Daniel M.
    Sklar, Charles A.
    Robison, Leslie L.
    Leisenring, Wendy M.
    [J]. BMJ-BRITISH MEDICAL JOURNAL, 2009, 339 : 34
  • [29] Nagueh SF, 2009, J AM SOC ECHOCARDIOG, V22, P107, DOI [10.1016/j.echo.2008.11.023, 10.1093/ejechocard/jep007]
  • [30] Cardiac Mechanics in Mild Hypertensive Heart Disease A Speckle-Strain Imaging Study
    Narayanan, Arumugam
    Aurigemma, Gerard P.
    Chinali, Marcello
    Hill, Jeffrey C.
    Meyer, Theo E.
    Tighe, Dennis A.
    [J]. CIRCULATION-CARDIOVASCULAR IMAGING, 2009, 2 (05) : 382 - 390