Longitudinal Changes in Echocardiographic Parameters of Cardiac Function in Pediatric Cancer Survivors

William L. Border, MBChB, MPH; Ritu Sachdeva, MBBS; Kayla L. Stratton, MS; Saro H. Armenian, DO, MPH; Aarti Bhat, MD; David E. Cox, RDCS; Kasey J. Leger, MD, MS; Wendy M. Leisenring, ScD; Lillian R. Meacham, MD; Karim T. Sadak, MD; Shanthi Sivanandam, MD; Paul C. Nathan, MD, MSc; Eric J. Chow, MD, MPH

JACC. CardioOncology (Mar 2020)

Longitudinal Changes in Echocardiographic Parameters of Cardiac Function in Pediatric Cancer Survivors

William L. Border, MBChB, MPH,
Ritu Sachdeva, MBBS,
Kayla L. Stratton, MS,
Saro H. Armenian, DO, MPH,
Aarti Bhat, MD,
David E. Cox, RDCS,
Kasey J. Leger, MD, MS,
Wendy M. Leisenring, ScD,
Lillian R. Meacham, MD,
Karim T. Sadak, MD,
Shanthi Sivanandam, MD,
Paul C. Nathan, MD, MSc,
Eric J. Chow, MD, MPH

Affiliations

William L. Border, MBChB, MPH: Emory University School of Medicine, Atlanta, Georgia, USA; Children’s Healthcare of Atlanta, Sibley Heart Center, Atlanta, Georgia, USA; Address for correspondence: Dr. William L. Border, Emory University School of Medicine, 1405 Clifton Road, Atlanta, Georgia 30322.
Ritu Sachdeva, MBBS: Emory University School of Medicine, Atlanta, Georgia, USA; Children’s Healthcare of Atlanta, Sibley Heart Center, Atlanta, Georgia, USA
Kayla L. Stratton, MS: Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
Saro H. Armenian, DO, MPH: Department of Population Sciences, City of Hope, Duarte, California, USA
Aarti Bhat, MD: Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, Washington, USA
David E. Cox, RDCS: Children’s Healthcare of Atlanta, Sibley Heart Center, Atlanta, Georgia, USA
Kasey J. Leger, MD, MS: Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, Washington, USA
Wendy M. Leisenring, ScD: Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
Lillian R. Meacham, MD: Emory University School of Medicine, Atlanta, Georgia, USA; Children’s Healthcare of Atlanta Aflac Cancer Center, Atlanta, Georgia, USA
Karim T. Sadak, MD: Department of Pediatrics, University of Minnesota, Masonic Children’s Hospital, Minneapolis, Minnesota, USA
Shanthi Sivanandam, MD: Department of Pediatrics, University of Minnesota, Masonic Children’s Hospital, Minneapolis, Minnesota, USA
Paul C. Nathan, MD, MSc: Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
Eric J. Chow, MD, MPH: Clinical Research and Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle, Washington, USA

Journal volume & issue: Vol. 2, no. 1
pp. 26 – 37

Abstract

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Objectives: The purpose of this study was to assess the timing of changes in serial echocardiographic parameters in pediatric cancer survivors and to evaluate their associations with cardiomyopathy development. Background: Pediatric cancer survivors undergo serial echocardiograms to screen for cardiotoxicity. It is not clear whether small longitudinal changes in functional or structural parameters over time have clinical significance. Methods: This is a multicenter, retrospective, case-control study of ≥1-year survivors following the end of cancer therapy. Cardiomyopathy cases (fractional shortening [FS] ≤28% or ejection fraction [EF] ≤50% on ≥2 occasions) were matched to control subjects (FS ≥30%, EF ≥55%, not on cardiac medications) by cumulative anthracycline and chest radiation dose, follow-up duration, and age at diagnosis. Digitally archived clinical surveillance echocardiograms were quantified in a central core laboratory, blinded to patient characteristics. Using mixed models with interaction terms between time and case status, we estimated the least square mean differences of 2-dimensional, M-mode, pulsed wave Doppler, and tissue Doppler imaging–derived parameters over time between cases and control subjects. Results: We identified 50 matched case-control pairs from 5 centers. Analysis of 412 echocardiograms (cases, n = 181; control subjects, n = 231) determined that indices of left ventricular systolic function (FS, biplane EF), diastolic function (mitral E/A ratio), and left ventricular size (end-diastolic dimension z-scores) were significantly different between cases and control subjects, even 4 years prior to the development of cardiomyopathy. Conclusions: Longitudinal changes in cardiac functional parameters can occur relatively early in pediatric cancer survivors and are associated with the development of cardiomyopathy.

Published in JACC. CardioOncology

ISSN: 2666-0873 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jacc-cardiooncology

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