Subclinical Cardiac Dysfunction in Childhood Cancer Survivors: Insights from Global Longitudinal Strain and Risk...

To evaluate subclinical cardiac dysfunction and its association with treatment exposure and metabolic risk factors in a cohort of asymptomatic childhood cancer survivors (CCS).

In this cross-sectional, observational, single-centre study, pediatric and young adult CCS were evaluated. Eligible participants were diagnosed before 18 years of age and had completed cancer therapy at least two years prior to enrolment. Data on cancer history, treatment exposures, and comorbidities were extracted from electronic medical records. Cardiovascular evaluation included history, physical examination, electrocardiogram, and comprehensive 2D-echocardiography with global longitudinal strain (GLS) analysis. Cumulative anthracycline-equivalent doses (CAE) and radiation exposure to the heart were documented.

Out of 456 CCS, anthracycline exposure was noted in 88% [mean (SD) CAE dose: 178.1 (123.2) mg/m²], and 6.3% had received cardiac radiation. The median (Q1, Q3) age at evaluation was 15 (10, 19) years, with a median (Q1, Q3) follow-up of 6.5 (4.9, 9.3) years. Left ventricular ejection fraction was reduced in 2.8%, while abnormal GLS was detected in 41.4%. On multivariable logistic regression, abnormal GLS was independently associated with CAE dose > 250 mg/m² (P = 0.012), obesity (P = 0.004) and hypertriglyceridemia (P = 0.05).

Abnormal GLS was prevalent in over 40% of asymptomatic CCS. Higher anthracycline exposure and presence of obesity and dyslipidemia were linked with subclinical cardiac dysfunction. These findings underscore the need for routine cardiac surveillance using strain imaging and aggressive management of modifiable risk factors to mitigate long-term cardiovascular morbidity in CCS.