Implementing strain imaging to identify early childhood cancer survivors at risk for cardiovascular disease.

e23070 Background: In patients receiving active chemotherapy, myocardial strain has prognostic utility for risk of subsequent cardiomyopathy. We hypothesized a decrement in strain in early off-treatment childhood cancer survivors (CCS) is prognostic for developing cardiomyopathy. Methods: Retrospective analysis was performed in 22 CCS. Global longitudinal strain (GLS) and global circumferential strain (GCS) were assessed at baseline and on the first end-of-treatment study with adequate imaging quality. Parametric methods assessed the association between changes in GLS/GCS and cardiovascular outcomes. Results: All CCS had normal echocardiograms at baseline and on the first end-of-treatment study . On long-term follow up 5/22 developed echocardiographic abnormalities defined as either left ventricular ejection fraction < 55% (n = 4) and/or left ventricular mass Z score < -2.0 (n = 4). Mean age at diagnosis was (mean ± SEM) 13.0 ± 1.3 and 10.7 ± 1.2, p = 0.37 for those without and with long-term abnormalities respectively. Patients who developed long-term echocardiographic abnormalities had a greater decrement in GCS between baseline and fist end-of-treatment echocardiograms (-6.9 ± 0.9% vs -0.7 ± 1.2%, p = 0.011) and a trend towards greater decrement in GLS (-1.5 ± 1.3% vs 1.2 ± 0.7%, p = 0.069). In early off-therapy CCS an absolute change in GCS of 7% was associated with subsequent cardiovascular dysfunction within 10 years. Conclusions: Change in GCS of 7% or greater from baseline to first end-of-treatment echocardiogram may identify CCS at risk for cardiomyopathy on long-term follow up and offer a window for early intervention. Strain imaging may provide an early method of identifying CCS at higher risk for developing cardiomyopathy on long-term follow up. These survivors may benefit from increased surveillance or early intervention with cardioprotective therapies.