Asymptomatic systolic dysfunction on contemporary echocardiography in anthracycline-treated long-term childhood cancer survivors: a systematic review

Abstract

Purpose Echocardiographic surveillance for asymptomatic left ventricular systolic dysfunction (ALVSD) is advised in childhood cancer survivors (CCS), because of their risk of heart failure after anthracycline treatment. ALVSD can be assessed with different echocardiographic parameters. We systematically reviewed the prevalence and risk factors of late ALVSD, as defined by contemporary and more traditional echocardiographic parameters. Methods We searched databases from 2001 to 2020 for studies on ≥ 100 asymptomatic 5-year CCS treated with anthracyclines, with or without radiotherapy involving the heart region. Outcomes of interest were prevalence of ALVSD—measured with volumetric methods (ejection fraction; LVEF), myocardial strain, or linear methods (fractional shortening; FS)—and its risk factors from multivariable analyses. Results Eleven included studies represented 3840 CCS. All studies had methodological limitations. An LVEF < 50% was observed in three studies in 1–6% of CCS, and reduced global longitudinal strain (GLS) was reported in three studies in 9–30% of CCS, both after a median follow-up of 9 to 23 years. GLS was abnormal in 20–28% of subjects with normal LVEF. Abnormal FS was reported in six studies in 0.3–30% of CCS, defined with various cut-off values (< 25 to < 30%), at a median follow-up of 10 to 18 years. Across echocardiographic parameters, reported risk factors were cumulative anthracycline dose and radiotherapy involving the heart region, with no ‘safe’ dose for ALVSD. Conclusions GLS identifies higher prevalence of ALVSD in anthracycline-treated CCS, than LVEF. Implications for Cancer Survivors The diagnostic and prognostic value of GLS should be evaluated within large cohorts. Protocol registration PROSPERO CRD42019126588

Cardiac Events in Childhood Cancer Survivors Treated with Anthracyclines: The Value of Previous Myocardial Strain Measurement

“…A recent systematic review showed that the use of longitudinal strain identifies a higher prevalence of asymptomatic left ventricular systolic dysfunction in anthracycline-treated CCS compared to the use of LVEF [ 13 ]. However, its prognostic implications in CCS remain unknown [ 5 , 14 ].…”

Childhood Cancer Survivors Have Impaired Strain-Derived Myocardial Contractile Reserve by Dobutamine Stress Echocardiography

“…The lack of pre-and during-treatment imaging suitable for GLS analysis could contribute to there still being little evidence linking reduced GLS to adverse outcomes in this population. However, given the large cumulative incidence of heart failure in CCS with a long latency time after cardiotoxic treatment [6], the mounting evidence that GLS is impaired in CCS, and that GLS precedes cardiotoxicity in adult cancer survivors, it is probably useful to include GLS in the long-term follow-up [34]. Further studies in this regard are warranted.…”

Anthracycline‐induced cardiotoxicity on regional myocardial work and left ventricular mechanical dispersion in adolescents and young adults in post‐lymphoma remission

“…Recently, the American Society of Echocardiography and European societies recommended the Global Longitudinal Strain (GLS), from speckle tracking echocardiography (STE), as a marker of myocardial dysfunction 8–11 . Indeed, it may be associated with an early sign of evolving cardiomyopathy among childhood cancer survivors treated with anthracyclines despite their normal LVEF 12–15 . However, GLS represents only one component of LV strains.…”

“…[8][9][10][11] Indeed, it may be associated with an early sign of evolving cardiomyopathy among childhood cancer survivors treated with anthracyclines despite their normal LVEF. [12][13][14][15] However, GLS represents only one component of LV strains. A comprehensive approach to assess LV systolic function needs to combine GLS with circumferential strains, 16 and also LV twisting mechanics.…”