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

Published online by Cambridge University Press:  27 November 2019

Jyothsna Akam-Venkata Open the ORCID record for Jyothsna Akam-Venkata [Opens in a new window] ,
Gilda Kadiu ,
James Galas ,
Steven E. Lipshultz  and
Sanjeev Aggarwal
Jyothsna Akam-Venkata*
Affiliation:
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
Gilda Kadiu
Affiliation:
Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
James Galas
Affiliation:
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
Steven E. Lipshultz
Affiliation:
Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, John R. Oishei Children’s Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Sanjeev Aggarwal
Affiliation:
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA Division of Cardiology, Children’s Hospital of Michigan, Detroit, MI, USA
*
Author for correspondence: J. Akam-Venkata, Division of Cardiology, Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, 3901 Beaubien Boulevard, Detroit, MI 48201, USA. Tel: +1-313-268-8942; Fax: +1-313-993-0894. E-mail: [email protected]
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Abstract

Aim:

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.

Keywords

Strainmalignancypaediatric echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1494 - 1500
Copyright
© Cambridge University Press 2019 

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References

American Cancer Society, 2017. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf (Accessed 1 June 2018).Google Scholar
Mariotto, AB, Rowland, JH, Yabroff, KR, et al. Long-term survivors of childhood cancers in the United States. Cancer Epidemiol Biomarkers Prev 2009; 18: 1033–1040.CrossRefGoogle ScholarPubMed
Weiss, RB, Sarosy, G, Clagett-Carr, K, et al. Anthracycline analogs: the past, present, and future. Cancer Chemother Pharmacol 1986; 18: 185–197.CrossRefGoogle ScholarPubMed
Lipshultz, SE, Lipsitz, SR, Sallan, SE, et al. Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia. J Clin Oncol 2005; 23: 2629–2636.CrossRefGoogle ScholarPubMed
Lipshultz, SE, Adams, MJ, Colan, SD, et al. 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. Circulation 2013; 128: 1927–1995.10.1161/CIR.0b013e3182a88099CrossRefGoogle Scholar
Aggarwal, S, Pettersen, MD, Bhambhani, K, et al. B-type natriuretic peptide as a marker for cardiac dysfunction in anthracycline-treated children. Pediatr Blood Cancer 2007; 49: 812–816.CrossRefGoogle ScholarPubMed
Schwartz, ML, Cox, GF, Lin, AE, et al. Clinical approach to genetic cardiomyopathy in children. Circulation 1996; 94: 2021–2038.10.1161/01.CIR.94.8.2021CrossRefGoogle ScholarPubMed
Nysom, K, Holm, K, Lipsitz, SR, et al. Relationship between cumulative anthracycline dose and late cardiotoxicity in childhood acute lymphoblastic leukemia. J Clin Oncol 1998; 16: 545–550.CrossRefGoogle ScholarPubMed
Children’s Oncology Group, 2013, October (Version 4.0). http://www.survivorshipguidelines.org/pdf/LTFUGuidelines_40.pdf (Accessed 1 June 2018).Google Scholar
Yu, HK, Yu, W, Cheuk, DK, et al. New three-dimensional speckle-tracking echocardiography identifies global impairment of left ventricular mechanics with a high sensitivity in childhood cancer survivors. J Am Soc Echocardiogr 2013; 26: 846–852.10.1016/j.echo.2013.04.018CrossRefGoogle ScholarPubMed
Geyer, H, Caracciolo, G, Abe, H, et al. Assessment of myocardial mechanics using speckle tracking echocardiography: fundamentals and clinical applications. J Am Soc Echocardiogr 2010; 23: 351–369; quiz 453-5.CrossRefGoogle ScholarPubMed
Sengelov, M, Jorgensen, PG, Jensen, JS, et al. Global longitudinal strain is a superior predictor of all-cause mortality in heart failure with reduced ejection fraction. JACC Cardiovasc Imaging 2015; 8: 1351–1359.10.1016/j.jcmg.2015.07.013CrossRefGoogle ScholarPubMed
Stoodley, PW, Richards, DA, Hui, R, et al. Two-dimensional myocardial strain imaging detects changes in left ventricular systolic function immediately after anthracycline chemotherapy. Eur J Echocardiogr 2011; 12: 945–952.10.1093/ejechocard/jer187CrossRefGoogle ScholarPubMed
Poterucha, JT, Kutty, S, Lindquist, RK, et al. Changes in left ventricular longitudinal strain with anthracycline chemotherapy in adolescents precede subsequent decreased left ventricular ejection fraction. J Am Soc Echocardiogr 2012; 25: 733–740.CrossRefGoogle ScholarPubMed
Amzulescu, MS, De Craene, M, Langet, H, et al. Myocardial strain imaging: review of general principles, validation, and sources of discrepancies. Eur Heart J Cardiovasc Imaging 2019; 20: 605–619.10.1093/ehjci/jez041CrossRefGoogle ScholarPubMed
Johnson, C, Kuyt, K, Oxborough, D, et al. Practical tips and tricks in measuring strain, strain rate and twist for the left and right ventricles. Echo Res Pract 2019; 6: R87–R98.CrossRefGoogle ScholarPubMed
Cerqueira, MD, Weissman, NJ, Dilsizian, V, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002; 105: 539–542.Google ScholarPubMed
Lang, RM, Badano, LP, Mor-Avi, V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28: 1-39 e14.CrossRefGoogle ScholarPubMed
Tsutsumi, T, Ishii, M, Eto, G, et al. Serial evaluation for myocardial performance in fetuses and neonates using a new Doppler index. Pediatr Int 1999; 41: 722–727.CrossRefGoogle ScholarPubMed
Ho, E, Brown, A, Barrett, P, et al. Subclinical anthracycline- and trastuzumab-induced cardiotoxicity in the long-term follow-up of asymptomatic breast cancer survivors: a speckle tracking echocardiographic study. Heart 2010; 96: 701–707.CrossRefGoogle ScholarPubMed
Pignatelli, RH, Ghazi, P, Reddy, SC, et al. Abnormal myocardial strain indices in children receiving anthracycline chemotherapy. Pediatr Cardiol 2015; 36: 1610–1616.CrossRefGoogle ScholarPubMed
Toro-Salazar, OH, Gillan, E, O′Loughlin, MT, et al. Occult cardiotoxicity in childhood cancer survivors exposed to anthracycline therapy. Circ Cardiovasc Imaging 2013; 6: 873–880.CrossRefGoogle ScholarPubMed
Sengupta, PP, Korinek, J, Belohlavek, M, et al. Left ventricular structure and function: basic science for cardiac imaging. J Am College Cardiol 2006; 48: 1988–2001.CrossRefGoogle ScholarPubMed
Bansal, M, Sengupta, PP. Longitudinal and circumferential strain in patients with regional LV dysfunction. Curr Cardiol Rep 2013; 15: 339.10.1007/s11886-012-0339-xCrossRefGoogle ScholarPubMed
Kalam, K, Otahal, P, Marwick, TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart 2014; 100: 1673–1680.CrossRefGoogle ScholarPubMed
Amundsen, BH, Helle-Valle, T, Edvardsen, T, et al. Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol 2006; 47: 789–793.10.1016/j.jacc.2005.10.040CrossRefGoogle ScholarPubMed
Becker, M, Bilke, E, Kuhl, H, et al. Analysis of myocardial deformation based on pixel tracking in two dimensional echocardiographic images enables quantitative assessment of regional left ventricular function. Heart 2006; 92: 1102–1108.CrossRefGoogle ScholarPubMed
Lorch, SM, Ludomirsky, A, Singh, GK. Maturational and growth-related changes in left ventricular longitudinal strain and strain rate measured by two-dimensional speckle tracking echocardiography in healthy pediatric population. J Am Soc Echocardiogr 2008; 21: 1207–1215.10.1016/j.echo.2008.08.011CrossRefGoogle ScholarPubMed
Plana, JC, Galderisi, M, Barac, A, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2014; 27: 911–939.10.1016/j.echo.2014.07.012CrossRefGoogle ScholarPubMed
Longobardo, L, Suma, V, Jain, R, et al. Role of two-dimensional speckle-tracking echocardiography strain in the assessment of right ventricular systolic function and comparison with conventional parameters. J Am Soc Echocardiogr 2017; 30: 937–46 e6.10.1016/j.echo.2017.06.016CrossRefGoogle ScholarPubMed
Harahsheh, A, Aggarwal, S, Pettersen, MD, et al. Diastolic function in anthracycline-treated children. Cardiol Young 2015; 25: 1130–1135.10.1017/S1047951114001760CrossRefGoogle ScholarPubMed
Ganame, J, Claus, P, Uyttebroeck, A, et al. Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patients. J Am Soc Echocardiogr 2007; 20: 1351–1358.10.1016/j.echo.2007.04.007CrossRefGoogle ScholarPubMed
Armenian, SH, Gelehrter, SK, Vase, T, et al. Screening for cardiac dysfunction in anthracycline-exposed childhood cancer survivors. Clin Cancer Res 2014; 20: 6314–6323.CrossRefGoogle ScholarPubMed