IntroductionMore than 90% of patients diagnosed with childhood acute lymphoblastic leukaemia (ALL) today will survive. However, half of the survivors are expected to experience therapy-related chronic or late occurring adverse effects, reducing quality of life. Insight into underlying risk trajectories is warranted. The aim of this study is to establish a Nordic, national childhood ALL survivor cohort, to be investigated for the total somatic and psychosocial treatment-related burden as well as associated risk factors, allowing subsequent linkage to nation-wide public health registers.Methods and analysisThis population-based observational cohort study includes clinical follow-up of a retrospective childhood ALL survivor cohort (n=475), treated according to a common Nordic ALL protocol during 2008–2018 in Denmark. The study includes matched controls. Primary endpoints are the cumulative incidence and cumulative burden of 197 health conditions, assessed through self-report and proxy-report questionnaires, medical chart validation, and clinical examinations. Secondary endpoints include organ-specific outcome, including cardiovascular and pulmonary function, physical performance, neuropathy, metabolic disturbances, hepatic and pancreatic function, bone health, oral and dental health, kidney function, puberty and fertility, fatigue, and psychosocial outcome. Therapy exposure, acute toxicities, and host genome variants are explored as risk factors.Ethics and disseminationThe study is approved by the Regional Ethics Committee for the Capital Region in Denmark (H-18035090/H-20006359) and by the Danish Data Protection Agency (VD-2018–519). Results will be published in peer-reviewed journals and are expected to guide interventions that will ameliorate the burden of therapy without compromising the chance of cure.

Estimation of LVEF by modern semi-automated 2D and 3D echocardiographic modalities is feasible, time-efficient, and reproducible.

No abstract

No abstract

Rationale & Objective Left ventricular (LV) mass (LVM) is a predictor of cardiovascular morbidity and mortality and commonly calculated using 1-dimensional (1D) echocardiographic methods. These methods are vulnerable to small measurement errors and LVM may wrongly change according to changes in LV volume (LVV). Less commonly used 2-dimensional (2D) methods can accommodate to the changes in LVV and may be a better alternative among patients receiving hemodialysis (HD) with large fluid fluctuations. Study Design Observational study. Setting & Participants Patients with end-stage kidney disease receiving HD. Exposure One HD session. Analytical Approach Transthoracic echocardiography was performed right before and after HD. LVM was calculated using 1D (Devereux, Penn, and Teichholz) and 2D methods (truncated ellipsoid and area-length). Outcomes Significant differences in LVM after HD. Results We compared dimensions, LVV and LVM, in 53 patients (mean age, 63 ± 15 years; 66% men). For each 1-L increase in ultrafiltration volume (UFV), LV internal diameter decreased 1.1 mm (95% CI, 0.5-1.7 mm; P = 0.001). Patients were divided into 2 groups by the median UFV of 1.6 L. Patients with UFV > 1.6 L had significant smaller LVV and LV internal diameter after HD. LVM calculated using 1D methods decreased according to changes in LVV. Conversely, LVM calculated using 2D methods was not significantly different after HD. No significant change in differences between diastolic − systolic myocardial thickness or LVM as assessed using 1D and 2D methods was observed before and after HD, indicating that LVM remained constant despite HD. Limitations We did not use contrast enhancement, 3-dimensional methods, or cardiac magnetic resonance. Conclusions LVM calculated using 2D methods, truncated ellipsoid and area-length, is less affected by fluctuations in fluid and LVV, in contrast to 1D methods. Complementary LVM calculation using 2D methods is encouraged, especially in patients with large fluid fluctuations in which increased LVM using a 1D method has been detected.

No abstract

Purpose Increased left ventricular mass (LVM) is a strong independent predictor for adverse cardiovascular events, but conventional echocardiographic methods used to assess and monitor individuals are limited by poor reproducibility and accuracy. We aimed to develop an echocardiographic method for LVM-quantification that is simple, reproducible and accurate. Methods The novel method adds the mean wall thickness to the left ventricular end-diastolic volume acquired using the biplane model of discs. The mean wall thickness is acquired from the parasternal short axis view. Cardiac assessment was performed using echocardiography followed immediately by cardiac magnetic resonance in 85 subjects with different left ventricular geometries, ranging from patients with various cardiac disorders (n=41) to individuals without known cardiac disorders (n=44). We compared the novel two-dimensional (2D) method to various conventional one-dimensional (1D) and 2D methods as well as three-dimensional (3D) echocardiography. Results The novel method had better reproducibility in intra-examiner (coefficients of variation (CV) 9% vs. 11-14%) and inter-examiner analysis (CV 9% vs. 10-20%) than the other methods. Accuracy of the novel method was similar to 3D (mean difference±95% limits of agreement, CV): Novel: 2±50g,15% vs. 3D: 2±51g, 16%; and better than the 1D-method by Devereux (7±76g, 23%). Conclusion The novel 2D-based method for LVM-quantification had better reproducibility than the other echocardiographic methods. Accuracy was similar to 3D and better than conventional methods. As endocardial tracings using the biplane model forms part of the standard echocardiographic protocol, the novel method can easily be integrated into any echocardiographic software, without substantially increasing analysis time.

No abstract