Cardiac Dysfunction After Childhood Cancer | Journal Scan

Study Questions:

What is the prevalence of cardiac dysfunction in adult survivors of childhood malignancies?


Patients treated for childhood cancer at St. Jude Children’s Research Hospital who were 18 years of age or older and 10 or more years from diagnosis were eligible to participate in the St. Jude Lifetime Cohort Study. Echocardiographic assessment included three-dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential myocardial strain and diastolic function, graded per American Society of Echocardiography (ASE) guidelines on 1,820 adult (median age 31 [range 18-65] years) survivors of childhood cancer (median time from diagnosis 23 [range 10-48] years) exposed to either anthracycline chemotherapy (n = 1,050), chest-directed radiotherapy (RT, n = 306), or both (n = 464).


Only 5.8% of survivors had an abnormal 3D LVEF (<50%). However, 32.1% of survivors with a normal 3D LVEF had evidence for cardiac dysfunction by global longitudinal strain (28.0%), ASE-graded diastolic assessment (8.7%), or both. Abnormal global longitudinal strain was associated with chest-directed RT (1-19.9 Gy, rate ratio [RR], 1.38, 95% confidence interval [CI] 1.14-1.66; 20-29.9 Gy, RR 1.65, 95% CI 1.31-2.08; >30 Gy, RR 2.39, 95% CI 1.79-3.18) and anthracycline dose >300 mg/m2 (RR, 1.72; 95% CI, 1.31-2.26). Survivors with metabolic syndrome were twice as likely to have abnormal global longitudinal strain (RR, 1.94; 95% CI, 1.66-2.28) and abnormal diastolic function (RR, 1.68; 95% CI, 1.39-2.03), but not abnormal 3D LVEF (RR, 1.07; 95% CI, 0.74-1.53).


The authors concluded that abnormal global longitudinal strain and diastolic function are more prevalent than reduced 3D LVEF, and are associated with treatment exposure.


This analysis suggests that standard echocardiographic evaluation of cardiac function in adult survivors of childhood cancer that focuses on LVEF as the primary measure of function may not be adequate. Evaluations that incorporate global longitudinal strain and ASE grading of diastolic function demonstrate evidence of cardiac dysfunction in one in three survivors with normal LVEF. Additional research is indicated to characterize the temporal evolution of structural and functional cardiac abnormalities during adulthood that arise as a consequence of therapy for cancer during childhood and predict adverse cardiac events.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, CHD and Pediatrics and Imaging, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Echocardiography/Ultrasound

Keywords: Anthracyclines, Child, Cohort Studies, Diastole, Diagnostic Imaging, Echocardiography, Metabolic Syndrome X, Neoplasms, Prevalence, Radiotherapy, Stroke Volume, Survivors, Ventricular Dysfunction

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