Cardiac Function After Cardiotoxic Treatments for Childhood Cancer-Left Ventricular Longitudinal Strain in Screening

Area of Science:

• Cardiology
• Pediatric Oncology
• Cardiovascular Imaging

Background:

• Childhood cancer survivors (CCSs) often experience cardiotoxic treatment effects.
• Many CCSs develop modifiable cardiovascular risk factors.
• Early detection of cardiac dysfunction is crucial for CCSs.

Purpose of the Study:

• To assess the utility of left ventricular (LV) longitudinal strain for enhancing cardiac dysfunction detection in CCSs.
• To compare the sensitivity of LV longitudinal strain against LV ejection fraction (EF).

Main Methods:

• Combined two national cohorts of neuroblastoma and other childhood cancer survivors.
• Included 90 long-term CCSs exposed to anthracyclines and/or high-dose chemotherapy with stem cell rescue (>5 years follow-up) and 86 controls.
• Assessed LV longitudinal strain using speckle tracking and LV EF via 3D echocardiography (3DE).

Main Results:

• 11% of CCSs exhibited abnormal LV longitudinal strain (< -17.5%).
• Among those with abnormal strain, 70% had normal 3DE LV EF, indicating missed dysfunction.
• Follow-up time, sex, and BMI were significantly associated with LV longitudinal strain, but not traditional cardiac risk factors.

Conclusions:

• LV longitudinal strain is a more sensitive biomarker for cardiac dysfunction in CCSs than LV EF.
• Incorporating LV longitudinal strain into screening protocols is recommended for CCSs.
• This is especially important for CCSs with modifiable cardiovascular risk factors to enable timely intervention.