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Mosgrove MJ, Sachdeva R, Stratton KL, Armenian SH, Bhat A, Leger KJ, Yang C, Leisenring WM, Meacham LR, Sadak KT, Narasimhan SL, Nathan PC, Chow EJ, Border WL. Utility of apical four-chamber longitudinal strain in the assessment of childhood cancer survivors: A multicenter study. Echocardiography 2024; 41:e15766. [PMID: 38340258 DOI: 10.1111/echo.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND A previous multicenter study showed that longitudinal changes in standard cardiac functional parameters were associated with the development of cardiomyopathy in childhood cancer survivors (CCS). Evaluation of the relationship between global longitudinal strain (GLS) changes and cardiomyopathy risk was limited, largely due to lack of quality apical 2- and 3-chamber views in addition to 4-chamber view. We sought to determine whether apical 4-chamber longitudinal strain (A4LS) alone can serve as a suitable surrogate for GLS in this population. METHODS A4LS and GLS were measured in echocardiograms with acceptable apical 2-, 3-, and 4-chamber views. Correlation was evaluated using Pearson and Spearman coefficients, and agreement was evaluated with Bland-Altman plots. The ability of A4LS to identify normal and abnormal values compared to GLS as the reference was evaluated. RESULTS Among a total of 632 reviewed echocardiograms, we identified 130 echocardiograms from 56 patients with adequate views (38% female; mean age at cancer diagnosis 8.3 years; mean follow-up 9.4 years). Correlation coefficients between A4LS and GLS were .89 (Pearson) and .85 (Spearman), with Bland-Altman plot of GLS-A4LS showing a mean difference of -.71 ± 1.8. Compared with GLS as the gold standard, A4LS had a sensitivity of 86% (95% CI 79%-93%) and specificity of 82% (69%-95%) when using normal range cutoffs and 90% (82%-97%) and 70% (58%-81%) when using ±2 standard deviations. CONCLUSION A4LS performs well when compared with GLS in this population. Given the more recent adoption of apical 2- and 3-chamber views in most pediatric echocardiography laboratories, A4LS is a reasonable stand-alone measurement in retrospective analyses of older study cohorts and echocardiogram biorepositories.
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Affiliation(s)
- Matthew J Mosgrove
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Medical Center, University of Texas Southwestern, Dallas, Texas, USA
| | - Ritu Sachdeva
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Aarti Bhat
- University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kasey J Leger
- University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Christina Yang
- University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
- Children's National Medical Center, George Washington University, Washington, District of Columbia, USA
| | | | | | - Karim T Sadak
- University of Minnesota, Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Shanti L Narasimhan
- University of Minnesota, Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Paul C Nathan
- University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric J Chow
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
- University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - William L Border
- Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Liu Q, Hu Y, Chen W, Yao T, Li W, Xiao Z, Liu J, Xiao Y. Evaluation of right ventricular longitudinal strain in pediatric patients with pulmonary hypertension by two-dimensional speckle-tracking echocardiography. Front Pediatr 2023; 11:1189373. [PMID: 37780047 PMCID: PMC10540637 DOI: 10.3389/fped.2023.1189373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives We aimed to investigate the association between right ventricular longitudinal strain measured by two-dimensional speckle-tracking echocardiography (2D-STE) and right heart catheterization data in pediatric patients with pulmonary hypertension (PH). Methods Two groups were evaluated, each consisting of 58 patients. Group 1, patients with PH; Group 2, normal matched controls. Data were collected from 58 patients with PH who underwent invasive hemodynamic evaluation. Standard transthoracic echocardiographic assessment was performed in all patients under the same circumstances. All patients underwent 2D-STE, and off-line analysis generated right ventricle longitudinal strain (RVLS) and right ventricular free wall strain (RVFW) and collected echocardiographic conventional parameters of right ventricular function, including the control group. The relationship between invasive characteristics and right ventricular function parameters was analyzed. Results In all, 58 PH patients were included in our study. The mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) were strongly correlated with right ventricular free wall strain (RVFW) and right ventricular longitudinal strain (RVLS), moderately correlated with the right ventricle myocardial performance index (Tei index), weakly correlated with the transverse diameter of the right ventricle (RV) and the transverse diameter of the right atrium (RA), and moderately negatively correlated with right ventricular fractional area change (RVFAC). In terms of segments of the right ventricular free wall, the basal segment had the highest correlation coefficient with mPAP and PVR (r = 0.413, 0.523, 0.578, r = 0.421, 0.533, 0.575, p < 0.05, respectively). Tricuspid annular plane systolic excursion (TAPSE), main pulmonary artery diameter (MPA), peak systolic velocity of the right ventricle (RV-S'), and RA area parameters were not associated with mPAP and PVR (p > 0.05). Conclusions Right ventricular longitudinal strain is a reliable indicator to evaluate right ventricular function in pediatric patients with PH. It can provide valuable reference information for the clinical judgment of the status and severity of the disease in children.
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Affiliation(s)
- Qianjun Liu
- Department of Ultrasound, Hunan Children’s Hospital, Changsha, China
| | - Yuan Hu
- Department of Ultrasound, Hunan Children’s Hospital, Changsha, China
| | - Wenjuan Chen
- Department of Ultrasound, Hunan Children’s Hospital, Changsha, China
| | - Taoyue Yao
- Department of Ultrasound, Hunan Children’s Hospital, Changsha, China
| | - Wenfeng Li
- Department of Ultrasound, Hunan Children’s Hospital, Changsha, China
| | - Zhenghui Xiao
- Intensive Care Unit, Hunan Children’s Hospital, Changsha, China
| | - Jinqiao Liu
- Department of Ultrasound, Hunan Children’s Hospital, Changsha, China
| | - Yunbin Xiao
- Department of Cardiology, Hunan Children’s Hospital, Changsha, China
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Alpman MS, Jarting A, Magnusson K, Manouras A, Henter J, Broberg AM, Herold N. Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience. Cancer Rep (Hoboken) 2023; 6:e1852. [PMID: 37354068 PMCID: PMC10480418 DOI: 10.1002/cnr2.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/14/2023] [Accepted: 06/11/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND The growing population of long-term childhood cancer survivors encounter a substantial burden of cardiovascular complications. The highest risk of cardiovascular complications is associated with exposure to anthracyclines and chest radiation. Longitudinal cardiovascular surveillance is recommended for childhood cancer patients; however, the optimal methods and timing are yet to be elucidated. AIMS We aimed to investigate the feasibility of different echocardiographic methods to evaluate left ventricular systolic function in retrospective datasets, including left ventricular ejection fraction (LVEF), fractional shortening (FS), global longitudinal strain (GLS) and longitudinal strain (LS) as well as the incidence and timing of subclinical left ventricular dysfunction detected by these methods. METHODS AND RESULTS A retrospective longitudinal study was performed with re-analysis of longitudinal echocardiographic data, acquired during treatment and early follow-up, including 41 pediatric sarcoma patients, aged 2.1-17.8 years at diagnosis, treated at Astrid Lindgren Children's Hospital, Stockholm, Sweden, during the period 2010-2021. All patients had received treatment according to protocols including high cumulative doxorubicin equivalent doses (≥250 mg/m2 ). In 68% of all 366 echocardiograms, LS analysis was feasible. Impaired LS values (<17%) was demonstrated in >40%, with concomitant impairment of either LVEF or FS in 20% and combined impairment of both LVEF and FS in <10%. Importantly, there were no cases of abnormal LVEF and FS without concomitant LS impairment. CONCLUSION Our findings demonstrate feasibility of LS in a majority of echocardiograms and a high incidence of impaired LS during anthracycline treatment for childhood sarcoma. We propose inclusion of LS in pediatric echocardiographic surveillance protocols.
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Affiliation(s)
- Maria Sjöborg Alpman
- Pediatric Cardiology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
| | - Annica Jarting
- Pediatric Cardiology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Kerstin Magnusson
- Pediatric Cardiology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Aristomenis Manouras
- Department of CardiologyKarolinska University HospitalStockholmSweden
- Department of MedicineKarolinska InstitutetStockholmSweden
| | - Jan‐Inge Henter
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Pediatric Oncology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Agneta Månsson Broberg
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Department of CardiologyKarolinska University HospitalStockholmSweden
- Department of MedicineKarolinska InstitutetStockholmSweden
| | - Nikolas Herold
- Pediatric Oncology, Department of Women's and Children's HealthKarolinska InstitutetStockholmSweden
- Pediatric Oncology, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
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Merkx R, Leerink JM, Feijen E(LA, de Baat EC, Bellersen L, Bresters D, van Dalen EC, van Dulmen-den Broeder E, van der Heiden-van der Loo M, van den Heuvel-Eibrink MM, Kok JL, Louwerens M, Maas AH, Neggers SJ, Ronckers CM, Teepen JC, Teske AJ, Tissing WJ, de Vries AC, Weijers G, de Korte CL, Loonen J, Mavinkurve-Groothuis AM, van der Pal HJ, Kremer LC, Kok WE, Kapusta L. Extensive Cardiac Function Analyses Using Contemporary Echocardiography in Childhood Cancer Survivors: A DCCSS LATER Study. JACC CardioOncol 2023; 5:472-485. [PMID: 37614574 PMCID: PMC10443197 DOI: 10.1016/j.jaccao.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 08/25/2023] Open
Abstract
Background Childhood cancer survivors (CCS) are at risk for cardiotoxicity. Objectives We sought to assess how cardiac dysfunction measurements in CCS overlap and are differentially influenced by risk factors. Methods This cross-sectional Dutch Childhood Cancer Survivor Study evaluated echocardiograms of 1,397 ≥5-year CCS and 277 siblings. Of CCS, n = 1,254 received cardiotoxic (anthracyclines/mitoxantrone/radiotherapy involving the heart region [RTheart]) and n = 143 received potentially cardiotoxic (cyclophosphamide, ifosfamide, or vincristine) therapy. We assessed demographic, treatment-related, and traditional cardiovascular risk factors for cardiac dysfunction using multivariable logistic regression. Results CCS were a median of 26.7 years after diagnosis; 49% were women. Abnormal left ventricular ejection fraction (LVEF) (defined as <52% in men, <54% in women) occurred most commonly in CCS treated with anthracyclines and RTheart combined (38%). Age/sex-specific abnormal global longitudinal strain (GLS) occurred most commonly in CCS treated with RTheart, either with (41%) or without (38%) anthracyclines. Of CCS with normal LVEF, 20.2% showed abnormal GLS. Diastolic dysfunction grade ≥II was rare. Abnormal LVEF was mainly associated with female sex, anthracycline dose, and only in women, RTheart dose. Abnormal GLS was associated with female sex, RTheart dose, diastolic blood pressure, and only in women, anthracycline dose. Cyclophosphamide, ifosfamide, and vincristine were not associated with LVEF or GLS. Compared with siblings, CCS showed higher risk of abnormal LVEF (OR: 2.9; 95% CI: 1.4-6.6) and GLS (OR: 2.1; 95% CI: 1.2-3.7), independent of (potentially) cardiotoxic treatment-related and cardiovascular risk factors. Conclusions Abnormal LVEF and GLS constitute complementary measures of systolic dysfunction among long-term CCS. Their diagnostic value may differ according to cardiotoxic exposures. Also, CCS have residual, unexplained risk of cardiac dysfunction. (Early Detection of Cardiac Dysfunction in Childhood Cancer Survivors, a DCOG LATER study; NTR7481).
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Affiliation(s)
- Remy Merkx
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
| | - Jan M. Leerink
- Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Esmée C. de Baat
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Louise Bellersen
- Cardiology, Radboud university medical center, Nijmegen, the Netherlands
| | - Dorine Bresters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | | | | | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Judith L. Kok
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marloes Louwerens
- Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Angela H.E.M. Maas
- Cardiology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Cécile M. Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Childhood Cancer Epidemiology/German Childhood Cancer Registry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jop C. Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Arco J. Teske
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wim J.E. Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Andrica C.H. de Vries
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gert Weijers
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
| | - Chris L. de Korte
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
| | - Jacqueline Loonen
- Hematology, Radboud university medical center, Nijmegen, the Netherlands
| | | | | | - Leontien C.M. Kremer
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Wouter E.M. Kok
- Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Livia Kapusta
- Pediatrics, Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiology, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, the Netherlands
| | - Dutch LATER Study Group
- Medical Imaging/Radiology, Medical UltraSound Imaging Centre, Radboud Institute for Health Sciences, Radboud university medical center, the Netherlands
- Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Cardiology, Radboud university medical center, Nijmegen, the Netherlands
- Pediatric Oncology, Amsterdam UMC, VU University, Amsterdam, the Netherlands
- Trial- and Data Center, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Pediatric Oncology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
- Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
- Childhood Cancer Epidemiology/German Childhood Cancer Registry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Pediatric Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Hematology, Radboud university medical center, Nijmegen, the Netherlands
- Pediatrics, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Pediatrics, Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Cardiology, Amalia Children’s Hospital, Radboud university medical center, Nijmegen, the Netherlands
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Broberg O, Øra I, Weismann CG, Wiebe T, Liuba P. Childhood Cancer Survivors Have Impaired Strain-Derived Myocardial Contractile Reserve by Dobutamine Stress Echocardiography. J Clin Med 2023; 12:jcm12082782. [PMID: 37109119 PMCID: PMC10145059 DOI: 10.3390/jcm12082782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Abnormal left ventricular contractile reserve (LVCR) is associated with adverse cardiac outcomes in different patient cohorts and might be useful in the detection of cardiomyopathy in childhood cancer survivors (CCS) after cardiotoxic treatment. The aim of this study was to evaluate LVCR by dobutamine stress echocardiography (DSE) combined with measures of myocardial strain in CCS previously treated with anthracyclines (AC). Fifty-three CCS (age 25.34 ± 2.44 years, 35 male) and 53 healthy controls (age 24.40 ± 2.40 years, 32 male) were included. Subjects were examined with echocardiography at rest, at low-dose (5 micrograms/kg/min), and at high-dose (40 micrograms/kg/min) dobutamine infusion. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), strain rate (GSR), and early diastolic strain rate (GEDSR) at different DSE phases were used as measures of LVCR. The mean follow-up time among CCS was 15.8 ± 5.8 years. GLS, GSR, and LVEF were lower at rest in CCS compared to controls (p ≤ 0.03). LVEF was within the normal range in CCS. ΔGLS, ΔGSR, and ΔGEDSR but not ΔLVEF were lower in CCS compared to controls after both low- (p ≤ 0.048) and high-dose dobutamine infusion (p ≤ 0.023). We conclude that strain measures during low-dose DSE detect impaired myocardial contractile reserve in young CCS treated with AC at 15-year follow-up. Thus, DSE may help identify asymptomatic CCS at risk for heart failure and allows for tailored follow-up accordingly.
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Affiliation(s)
- Olof Broberg
- Department of Pediatric Cardiology, Skane University Hospital, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
| | - Ingrid Øra
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Constance G Weismann
- Department of Pediatric Cardiology, Skane University Hospital, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig-Maximilian University, 80539 Munich, Germany
| | - Thomas Wiebe
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
- Department of Pediatric Oncology, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Petru Liuba
- Department of Pediatric Cardiology, Skane University Hospital, SE-221 85 Lund, Sweden
- Department of Clinical Sciences, Pediatrics, Lund University, SE-221 85 Lund, Sweden
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Camilli M, Skinner R, Iannaccone G, La Vecchia G, Montone RA, Lanza GA, Natale L, Crea F, Cameli M, Del Buono MG, Lombardo A, Minotti G. Cardiac Imaging in Childhood Cancer Survivors: A State-of-the-Art Review. Curr Probl Cardiol 2023; 48:101544. [PMID: 36529231 DOI: 10.1016/j.cpcardiol.2022.101544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Childhood cancer survival has improved significantly in the past few decades, reaching rates of 80% or more at 5 years. However, with improved survival, early- and late-occurring complications of chemotherapy and radiotherapy exposure are becoming progressively more evident. Cardiovascular diseases represent the leading cause of non-oncological morbidity and mortality in this highly vulnerable population. Therefore, the necessity of reliable, noninvasive screening tools able to early identify cardiac complications early is now pre-eminent in order to implement prevention strategies and mitigate disease progression. Echocardiography, may allow identification of myocardial dysfunction, pericardial complications, and valvular heart diseases. However, additional imaging modalities may be necessary in selected cases. This manuscript provides an in-depth review of noninvasive imaging parameters studied in childhood cancer survivors. Furthermore, we will illustrate brief surveillance recommendations according to available evidence and future perspectives in this expanding field.
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Affiliation(s)
- Massimiliano Camilli
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco Antonio Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Antonio Lanza
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Natale
- Radiological, Radiotherapic and Haematological Sciences, Fondazione Policlinico Universitario Gemelli-IRCCS, Università Cattolica S. Cuore Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Antonella Lombardo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giorgio Minotti
- Department of Medicine, Center for Integrated Research and Unit of Drug Sciences, Campus Bio-Medico University and Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Guida F, Masetti R, Andreozzi L, Zama D, Fabi M, Meli M, Prete A, Lanari M. The Role of Nutrition in Primary and Secondary Prevention of Cardiovascular Damage in Childhood Cancer Survivors. Nutrients 2022; 14:3279. [PMID: 36014785 PMCID: PMC9415958 DOI: 10.3390/nu14163279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 12/03/2022] Open
Abstract
Innovative therapeutic strategies in childhood cancer led to a significant reduction in cancer-related mortality. Cancer survivors are a growing fragile population, at risk of long-term side effects of cancer treatments, thus requiring customized clinical attention. Antineoplastic drugs have a wide toxicity profile that can limit their clinical usage and spoil patients’ life, even years after the end of treatment. The cardiovascular system is a well-known target of antineoplastic treatments, including anthracyclines, chest radiotherapy and new molecules, such as tyrosine kinase inhibitors. We investigated nutritional changes in children with cancer from the diagnosis to the end of treatment and dietary habits in cancer survivors. At diagnosis, children with cancer may present variable degrees of malnutrition, potentially affecting drug tolerability and prognosis. During cancer treatment, the usage of corticosteroids can lead to rapid weight gain, exposing children to overweight and obesity. Moreover, dietary habits and lifestyle often dramatically change in cancer survivors, who acquire sedentary behavior and weak adherence to dietary guidelines. Furthermore, we speculated on the role of nutrition in the primary prevention of cardiac damage, investigating the potential cardioprotective role of diet-derived compounds with antioxidative properties. Finally, we summarized practical advice to improve the dietary habits of cancer survivors and their families.
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Nappi C, Megna R, Volpe F, Ponsiglione A, Caiazzo E, Piscopo L, Mainolfi CG, Vergara E, Imbriaco M, Klain M, Petretta M, Cuocolo A. Quantification of Coronary Artery Atherosclerotic Burden and Muscle Mass: Exploratory Comparison of Two Freely Available Software Programs. Applied Sciences 2022; 12:5468. [DOI: 10.3390/app12115468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Coronary artery calcification and sarcopenia may have a relevant prognostic impact in oncological and non-oncological patients. The use of freeware software is promising for quantitative evaluation of these parameters after whole-body positron emission tomography (PET)/computed tomography (CT) and might be useful for one-stop shop risk stratification without additional radiation ionizing burden and further charges to health care costs. In this study, we compared two semiautomatic freeware software tools (Horos Medical Image software and LIFEx) for the assessment of coronary artery calcium (CAC) score and muscle mass in 40 patients undergoing whole-body PET/CT. The muscle areas obtained by the two software programs were comparable, showing high correlation with Lin’s concordance coefficient (0.9997; 95% confidence intervals: 0.9995–0.9999) and very good agreement with Bland–Altman analysis (mean difference = 0.41 cm2, lower limit = −1.06 cm2, upper limit = 1.89) was also found. For CAC score, Lin’s concordance correlation coefficient was 0.9976 (95% confidence intervals: 0.9965–0.9984) and in a Bland–Altman analysis an increasing mean difference from 8 to 78 by the mean values (intercept = −0.050; slope = 0.054; p < 0.001) was observed, with a slight overestimation of Horos CAC score as compared to LIFEx, likely due to a different calculation method of the CAC score, with the ROI being equal for the two software programs. Our results demonstrated that off-line analysis performed with freeware software may allow a comprehensive evaluation of the oncological patient, making available the evaluation of parameters, such as muscle mass and calcium score, that may be relevant for the staging and prognostic stratification of these patients, beside standard data obtained by PET/CT imaging. For this purpose, the Horos and LIFEx software seem to be interchangeable.
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Gonzalez-Manzanares R, Castillo JC, Molina JR, Ruiz-Ortiz M, Mesa D, Ojeda S, Anguita M, Pan M. Automated Global Longitudinal Strain Assessment in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia. Cancers (Basel) 2022; 14:cancers14061513. [PMID: 35326663 PMCID: PMC8946759 DOI: 10.3390/cancers14061513] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
There is limited evidence that supports the use of the global longitudinal strain (GLS) in long-term cardiac monitoring of childhood acute lymphoblastic leukemia survivors (CLSs). Our aim was to assess the utility of automated GLS to detect left ventricular systolic dysfunction (LVSD) in long-term CLSs. Asymptomatic and subclinical LVSD were defined as LVEF < 50% and GLS < 18.5%, respectively. Echocardiographic measurements and biomarkers were compared with a control group. Inverse probability weighting was used to reduce confounding. Regression models were used to identify factors associated with LVEF and GLS in the survivors. Ninety survivors with a median follow-up of 18 (11−26) years were included. The prevalence of LVSD was higher using GLS than with LVEF (26.6% vs. 12.2%). The measurements were both reduced as compared with the controls (p < 0.001). There were no differences in diastolic parameters and NT-ProBNP. Survivors were more likely to have Hs-cTnI levels above the detection limit (40% vs. 17.2%, p = 0.006). The dose of anthracycline was associated with LVEF but not with GLS in the survivors. Biomarkers were not associated with GLS or LVEF. In conclusion, LVSD detection using automated GLS was higher than with LVEF in long-term CLSs. Its incorporation into clinical routine practice may improve the surveillance of these patients.
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Affiliation(s)
- Rafael Gonzalez-Manzanares
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.C.C.); (M.R.-O.); (D.M.); (S.O.); (M.A.); (M.P.)
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
- Correspondence:
| | - Juan C. Castillo
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.C.C.); (M.R.-O.); (D.M.); (S.O.); (M.A.); (M.P.)
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
| | - Jose R. Molina
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
- Hematology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain
| | - Martin Ruiz-Ortiz
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.C.C.); (M.R.-O.); (D.M.); (S.O.); (M.A.); (M.P.)
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
| | - Dolores Mesa
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.C.C.); (M.R.-O.); (D.M.); (S.O.); (M.A.); (M.P.)
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
| | - Soledad Ojeda
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.C.C.); (M.R.-O.); (D.M.); (S.O.); (M.A.); (M.P.)
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
- Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
| | - Manuel Anguita
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.C.C.); (M.R.-O.); (D.M.); (S.O.); (M.A.); (M.P.)
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
| | - Manuel Pan
- Cardiology Department, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.C.C.); (M.R.-O.); (D.M.); (S.O.); (M.A.); (M.P.)
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), 14004 Cordoba, Spain;
- Faculty of Medicine and Nursing, University of Cordoba, 14004 Cordoba, Spain
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