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

2019 ◽  
Vol 29 (12) ◽  
pp. 1494-1500
Author(s):  
Jyothsna Akam-Venkata ◽  
Gilda Kadiu ◽  
James Galas ◽  
Steven E. Lipshultz ◽  
Sanjeev Aggarwal
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Global Longitudinal Strain ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
Normal Left Ventricular ◽  
Fractional Shortening ◽  
Anthracycline Chemotherapy

AbstractAim: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.

scholarly journals Asymptomatic systolic dysfunction on contemporary echocardiography in anthracycline-treated long-term childhood cancer survivors: a systematic review

2021 ◽  
Author(s):  
Remy Merkx ◽  
Jan M. Leerink ◽  
Esmée C. de Baat ◽  
Elizabeth A. M. Feijen ◽  
Wouter E. M. Kok ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
Heart Region ◽  
Echocardiographic Parameters

Abstract Purpose Echocardiographic surveillance for asymptomatic left ventricular systolic dysfunction (ALVSD) is advised in childhood cancer survivors (CCS), because of their risk of heart failure after anthracycline treatment. ALVSD can be assessed with different echocardiographic parameters. We systematically reviewed the prevalence and risk factors of late ALVSD, as defined by contemporary and more traditional echocardiographic parameters. Methods We searched databases from 2001 to 2020 for studies on ≥ 100 asymptomatic 5-year CCS treated with anthracyclines, with or without radiotherapy involving the heart region. Outcomes of interest were prevalence of ALVSD—measured with volumetric methods (ejection fraction; LVEF), myocardial strain, or linear methods (fractional shortening; FS)—and its risk factors from multivariable analyses. Results Eleven included studies represented 3840 CCS. All studies had methodological limitations. An LVEF < 50% was observed in three studies in 1–6% of CCS, and reduced global longitudinal strain (GLS) was reported in three studies in 9–30% of CCS, both after a median follow-up of 9 to 23 years. GLS was abnormal in 20–28% of subjects with normal LVEF. Abnormal FS was reported in six studies in 0.3–30% of CCS, defined with various cut-off values (< 25 to < 30%), at a median follow-up of 10 to 18 years. Across echocardiographic parameters, reported risk factors were cumulative anthracycline dose and radiotherapy involving the heart region, with no ‘safe’ dose for ALVSD. Conclusions GLS identifies higher prevalence of ALVSD in anthracycline-treated CCS, than LVEF. Implications for Cancer Survivors The diagnostic and prognostic value of GLS should be evaluated within large cohorts. Protocol registration PROSPERO CRD42019126588

scholarly journals Cardiac Function After Cardiotoxic Treatments for Childhood Cancer—Left Ventricular Longitudinal Strain in Screening

2021 ◽  
Vol 8 ◽  
Author(s):  
Jussi Niemelä ◽  
Kaisa Ylänen ◽  
Anu Suominen ◽  
Kuberan Pushparajah ◽  
Sujeev Mathur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cardiovascular Risk Factors ◽  
Cardiac Dysfunction ◽  
Longitudinal Strain ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
High Dose

Background: The majority of childhood cancer survivors (CCSs) have been exposed to cardiotoxic treatments and often present with modifiable cardiovascular risk factors. Our aim was to evaluate the value of left ventricular (LV) longitudinal strain for increasing the sensitivity of cardiac dysfunction detection among CCSs.Methods: We combined two national cohorts: neuroblastoma and other childhood cancer survivors treated with anthracyclines. The final data consisted of 90 long-term CCSs exposed to anthracyclines and/or high-dose chemotherapy with autologous stem cell rescue and followed up for &gt; 5 years and their controls (n = 86). LV longitudinal strain was assessed with speckle tracking (Qlab) and LV ejection fraction (EF) by three-dimensional echocardiography (3DE).Results: Of the CCSs, 11% (10/90) had abnormal LV longitudinal strain (i.e., &lt; -17.5%); of those, 70% (7/10) had normal 3DE LV EF. Multivariable linear model analysis demonstrated that follow-up time (p = 0.027), sex (p = 0.020), and BMI (p = 0.002) were significantly associated with LV longitudinal strain. Conversely, cardiac risk group, hypertension, age, cumulative anthracycline dose or exposure to chest radiation were not.Conclusion: LV longitudinal strain is a more sensitive method than LV EF for the detection of cardiac dysfunction among CCSs. Therefore, LV longitudinal strain should be added to the screening panel, especially for those with modifiable cardiovascular risk factors.

Biomarkers to diagnose ventricular dysfunction in childhood cancer survivors: a systematic review

Heart ◽  
2018 ◽  
Vol 105 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Jan M Leerink ◽  
Simone J Verkleij ◽  
Elizabeth A M Feijen ◽  
Annelies M C Mavinkurve-Groothuis ◽  
Milanthy S Pourier ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Natriuretic Peptide ◽  
Late Onset ◽  
Childhood Cancer Survivors ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Lv Dysfunction ◽  
Low Sensitivity ◽  
Fractional Shortening

ObjectiveTo systematically review the literature and assess the diagnostic value of biomarkers in detection of late-onset left ventricular (LV) dysfunction in childhood cancer survivors (CCS) treated with anthracyclines.MethodsWe systematically searched the literature for studies that evaluated the use of biomarkers for detection of LV dysfunction in CCS treated with anthracyclines more than 1 year since childhood cancer diagnosis. LV dysfunction definitions were accepted as an ejection fraction <50% or <55% and/or a fractional shortening <28%, <29% or <30%. Contingency tables were created to assess diagnostic accuracies of biomarkers for diagnosing LV dysfunction.ResultsOf 1362 original studies screened, eight heterogeneous studies evaluating four different biomarkers in mostly asymptomatic CCS were included. In four studies, an abnormal N-terminal pro-B-type natriuretic peptide (NT-proBNP, cut-off range 63–125 ng/L) had low sensitivity (maximally 22%) and a specificity of up to 97% for detection of LV dysfunction. For troponin levels, in five studies one patient had an abnormal troponin value as well as LV dysfunction, while in total 127 patients had LV dysfunction without troponin elevations above cut-off values (lowest 0.01 ng/mL). Two studies that evaluated brain natriuretic peptide and nitric oxide were underpowered to draw conclusions.ConclusionsIn individual studies, the diagnostic value of NT-proBNP for detection of LV dysfunction in CCS is limited. Troponins have no role in detecting late-onset LV dysfunction with cut-off values as low as 0.01 ng/mL. Further study on optimal NT-proBNP cut-off values for rule out or rule in of LV dysfunction is warranted.

scholarly journals Left ventricular dyssynchrony in long-term childhood cancer survivors treated with anthracyclines: a retrospective cross-sectional study

2021 ◽  
Author(s):  
Milanthy S. Pourier ◽  
Myrthe M. Dull ◽  
Gert Weijers ◽  
Jacqueline Loonen ◽  
Louise Bellersen ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Longitudinal Strain ◽  
Lateral Wall ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
Left Ventricular Dyssynchrony ◽  
Systolic Strain ◽  
Ventricular Dyssynchrony ◽  
Dyssynchrony Index

AbstractThe purpose of this study was to investigate left ventricular contraction patterns in asymptomatic Childhood cancer survivors (CCS) using two-dimensional speckle tracking echocardiography (2DSTE). Left ventricular longitudinal and circumferential myocardial parameters were assessed using 2DSTE, in asymptomatic CCS and age matched healthy controls. Time to peak (T2P) systolic strain was quantified. Dyssynchrony index (DI) was measured by calculating the standard deviation of T2P systolic strain of six segments in each view. Difference between T2P systolic longitudinal strain of septal and lateral wall was also assessed as a parameter for dyssynchrony. We included 115 CCS with a median age of 17.2 years (range 5.6–39.5) and a median follow up of 11.3 years (range 4.9–29.5) and 119 controls. Conventional echocardiographic parameters and global longitudinal strain were significantly decreased in CCS compared to controls (p < 0.01 and p = 0.02, respectively). Dyssynchrony index did not differ between CCS and controls. There was a clinically insignificant smaller absolute difference between T2P systolic longitudinal of septal and lateral wall in CCS compared to controls. We showed no difference in longitudinal or circumferential left ventricular dyssynchrony in CCS compared to controls using 2DSTE. Future research should focus on assessing dyssynchrony in more segments and a larger CCS population, using both 2D and 3DSTE.

Circumferential deformation in diagnosis and risk assessment of patients with left ventricular non-compaction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Anwer ◽  
P.S Heiniger ◽  
S Rogler ◽  
D Cassani ◽  
L Rebellius ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Strong Association ◽  
Global Longitudinal Strain ◽  
Diagnostic Algorithm ◽  
Left Ventricular ◽  
Deformation Analysis ◽  
Funding Source ◽  
Apical Rotation ◽  
Increased Risk

Abstract Introduction Echocardiography-based deformation analysis is used for studying left ventricular (LV) mechanics and have an emerging role in the diagnosis of cardiomyopathies. Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterised by a two-layered LV myocardium with prominent trabeculae separated by deep recesses perfused from the LV cavity. Left ventricular hypertrabeculation (LVHT) may be difficult to differentiate from LVNC. In this study, we aim to develop a diagnostic algorithm based on the circumferential deformation (CD) of LVNC, LVHT and controls; and find their associations with LVNC outcomes. Methods We compared 45 LVNC patients, 45 LVHT individuals, and 45 matched healthy controls. LVNC was diagnosed according to current echocardiographic criteria. LVHT was defined as presence of three or more trabeculae in the LV apex visualised in both parasternal short axis and apical views. Controls had a normal echocardiographic examination and no evidence of cardiovascular disease. Strain analysis was performed using TomTec Image-Arena (version 4.6). Results Receiver observer characteristics curve (ROC) analyses revealed that GCS &lt;22.3% differentiated LVNC from control or LVHT. In individuals with global circumferential strain (GCS) below 22.3%, an apical peak circumferential strain (PCS) cut-off value of 18.4% differentiated LVNC [&lt;18.4%] and LVHT [≥18.4%] (fig. 1). An independent echocardiographer (Table 1) performed blind validation of diagnosis on 32 subjects from each group. Combined endpoint of cardiovascular events in LVNC (CVE) is described in figure 2. Multi-variate regression analyses have shown that GCS was associated with 11-fold increased risk of CVE independent of LVEF and NC:C ratio, while global longitudinal strain (GLS) displayed only 2-fold increased risk. Regional basal and apical peak circumferential or longitudinal strain, left ventricular twist, basal-apical rotation ratio have shown significant associations (Fig. 3). Conclusions A diagnostic algorithm with GCS and aPCS (threshold value 18.4%) differentiates LVNC from LVHT and control with very high sensitivity and specificity independent of additional echocardiographic or clinical information. Circumferential strain derived parameters exhibit a very strong association with outcomes independent of LVEF and NC:C ratio. Absence of CVE in LVHT provides further evidence on the distinct nature of LVNC and LVHT. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): 2018 research grant from the Swiss Heart Foundation

scholarly journals Anthracycline-Induced Cardiotoxicity in Young Cancer Patients: The Role of Carnitine

2016 ◽  
Vol 68 (Suppl. 3) ◽  
pp. 10-14 ◽  
Author(s):  
Saro H. Armenian
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Cancer Patients ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Childhood Cancer Survivors ◽  
Chronic Health Condition ◽  
Cardiovascular Complications ◽  
Left Ventricular

While the increased rates of survival in childhood cancers have increased progressively in recent decades, many childhood cancer survivors will have at least one chronic health condition within 40 years of age. In this regard, cardiovascular complications have emerged as a leading cause of long-term morbidity and mortality in long-term survivors of childhood cancer, likely due to exposure to anthracycline chemotherapy, and outcomes in patients with anthracycline-related cardiomyopathy remain poor. Some progress has been made in understanding the mechanisms at the basis of anthracycline-related cardiomyopathy, which appear to involve generation of reactive oxygen species, leading to mitochondrial dysfunction, followed by myocyte apoptosis and maladaptive left ventricular remodeling. Even if several guidelines currently exist for monitoring cancer patients treated with cardiotoxic therapies who are at high risk for heart failure, much work remains to be done in finding reliable markers for screening for cardiac dysfunction. Studies from our group have identified alterations in L-carnitine in cancer survivors. While additional investigations are needed, preliminary studies suggest a role for carnitine in primary prevention (during treatment) and secondary prevention (to improve function after treatment).

Abstract 18181: Left Ventricular Myocardial Mechanics at Rest and During Exercise in Children After Arterial Switch Operation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Barbara Cifra ◽  
Andreea Dragulescu ◽  
Heynric Grotenhuis ◽  
Cedric Manlhiot ◽  
Mark K Friedberg ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Longitudinal Strain ◽  
Circumferential Strain ◽  
Arterial Switch Operation ◽  
Global Longitudinal Strain ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Arterial Switch ◽  
Switch Operation

Introduction: Arterial switch operation (ASO) is the standard surgical procedure for transposition of the great arteries allowing a complete anatomical and physiological repair. In these patients the functional impact of myocardial perfusion on global and regional myocardial function has not been investigated. Stress echocardiography with visual myocardial assessment has been used to detect regional myocardial dysfunction. Studying LV mechanics using speckle-tracking echocardiography during exercise could provide more quantitative information. The aim of the study was to study the myocardial response to exercise in children after ASO using semi-supine cycle ergometry stress echocardiography (SSCE). Materials and Methods: Forty children after ASO and 29 age and gender matched controls were included. Median age was 14 years. A stepwise SSCE protocol was used. LV global longitudinal strain and circumferential strain was measured in all subjects at rest and at incremental heart rate. Results: Resting HR was similar between groups, peak HR was lower in the ASO group compared with controls (142 ±11 vs 157±14 bpm, p=0.0007). LV global longitudinal strain was lower at rest (19±2.3% vs. 21±2.5%, p=0.004) but not at peak exercise (22.7±5.6 % vs. 24±4.5 % p=0.2) in the ASO group compared to controls. No significant difference was found in LV global circumferential strain at rest (23.7±2.3% vs. 24±3.2 %, p=0.6) and peak exercise (28±2.6% vs. 27.9±4.1 %, p=0.9). Also when plotted versus heart rates the increase in longitudinal and circumferential strain values were not significantly different. Conclusions: These data show that circumferential and longitudinal myocardial deformation during exercise is preserved in children after ASO compared to controls. Earlier data obtained using Tissue Doppler in the same study cohort, showed a normal increase in systolic tissue Doppler velocities. These data suggest a preserved LV reserve during exercise in this patient cohort.

scholarly journals Exercise Interventions and Cardiovascular Health in Childhood Cancer: A Meta-analysis

2020 ◽  
Vol 41 (03) ◽  
pp. 141-153 ◽  
Author(s):  
Javier S. Morales ◽  
Pedro L. Valenzuela ◽  
Alba M. Herrera-Olivares ◽  
Antonio Baño-Rodrigo ◽  
Adrián Castillo-García ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Meta Analysis ◽  
Childhood Cancer Survivors ◽  
Left Ventricular ◽  
Mean Difference ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Exercise Interventions

AbstractThis study analyzed the effects of physical exercise interventions on cardiovascular endpoints in childhood cancer survivors. Relevant articles were systematically searched in PubMed, CINAHL, and Web of Science databases (since inception to 11th September 2019). We performed a meta-analysis (random effects) to determine the mean difference (expressed together with 95% confidence intervals) between pre- and post-intervention values for those cardiovascular endpoints reported in more than three studies. Twenty-seven studies (of which 16 were controlled studies) comprising 697 participants were included. Only three studies reported adverse events related to exercise interventions. Exercise resulted in an increased performance on the 6-minute walk distance test (mean difference=111 m, 95% confidence interval=39–183, p=0.003) and a non-significant trend (mean difference=1.97 ml∙kg−1∙min−1, 95% confidence interval=−0.12–4.06, p=0.065) for improvement in peak oxygen uptake. Furthermore, left ventricular ejection fraction was preserved after exercise interventions (mean difference=0.29%, 95% confidence interval=−1.41–1.99, p=0.738). In summary, exercise interventions might exert a cardioprotective effect in childhood cancer survivors by improving – or attenuating the decline of – physical capacity and cardiovascular function. Further studies, particularly randomized controlled trials, are needed to confirm these benefits.

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