In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Childhood Cancer After Anthracycline Treatment Using Layer-Specific Strain Analysis

Yazaki, Kana; Takahashi, Ken; Shigemitsu, Sachie; Yamada, Mariko; Iso, Takashi; Kobayashi, Maki; Akimoto, Katsumi; Tamaichi, Hiroyuki; Fujimura, Junya; Saito, Masahiro; Nii, Masaki; Shimizu, Toshiaki

doi:10.1253/circj.cj-17-0874

Cited by 20 publications

(15 citation statements)

References 33 publications

(27 reference statements)

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“…27 Sub-endocardium circumferential deformation and apical rotation are preferentially impaired with consequential reduction of transmural CS, and rotation gradients occur in anthracyclinetreated survivors of childhood cancers. 24,28 Basal endocardium CS was found to be the initial parameter indicating damage, occurring after 2 cycles of chemotherapy in this study, which is consistent with previous studies.…”

Section: Discussionsupporting

confidence: 92%

“…Myocardial mechanical deformation in three layers can be quantified by measuring the values of layer‐specific strain, including longitudinal‐ and circumferential‐layer strains of the endocardium, mid‐myocardium, and epicardium . In addition, anthracycline‐caused impairment of myocardial CS has a horizontal transmural gradient going from endocardium to epicardium, and from basal toward the apical level . Animal models of anthracycline cardiotoxicity demonstrated that myocytolysis mainly involved sub‐endocardium and mid‐myocardium layers .…”

Section: Discussionmentioning

confidence: 99%

“…17 In addition, anthracyclinecaused impairment of myocardial CS has a horizontal transmural gradient going from endocardium to epicardium, and from basal toward the apical level. 24 Animal models of anthracycline cardiotoxicity demonstrated that myocytolysis mainly involved sub-endocardium and mid-myocardium layers. 25,26 Clinical trials also demonstrated that anthracycline induced sub-endocardium late gadolinium enhancement, indicating earlier occurrence of sub-endocardium myocardial fibrosis.…”

Section: Discussionmentioning

confidence: 99%

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The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

Liu

et al. 2019

Echocardiography

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Purpose The primary aim of this study was to evaluate early changes in cardiac function after anthracycline therapy with layer‐specific speckle‐tracking echocardiography (STE) and mechanical dys‐synchrony. Methods A total of 78 breast cancer patients (ranging 31~72 years) exposed to anthracycline treatment were recruited in this study. All patients received both conventional two‐dimensional speckle‐tracking echocardiographs at baseline, as well as after the completion of 2 and 4 cycles of the regimen. Layer‐specific longitudinal strain (LS) and circumferential strain (CS) of the 3 myocardial layers (endocardium, mid‐myocardium, and epicardium) were automatically measured. Peak systolic dispersion (PSD) was defined as the standard deviation of the time to peak strain of the 18 segments, divided by the RR interval. Results There were no significant differences in conventional echocardiographic parameters during treatment (all P > .05). Peak endocardium CS at basal level decreased significantly after 2 and 4 cycles compared with baseline (both P = .001), while PSD significantly increased in that same period versus baseline (both P = .000). Endocardium and mid‐myocardium LS, peak mid‐myocardium and epicardium CS at the basal level, peak CS of all three layers at the papillary level, and peak endocardium and mid‐myocardium CS at the apical level all significantly decreased after 4 cycles, compared with baseline and 2 cycles (all P = .000). Conclusion This study showed that myocardial deformation impairment occurred as early as 2 cycles after anthracycline chemotherapy. Endocardium CS at the basal level and left ventricular dys‐synchrony index PSD were the initial cardiac abnormalities in anthracycline‐treated breast cancer patients.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

Liu

et al. 2019

Echocardiography

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“…Strain was measured using 2D speckle-tracking echocardiography as described in previous reports (Figure 1). 22,23 All data were measured at least 3 times, and the averages are reported.…”

Section: Deformation Analysismentioning

confidence: 99%

In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Type 1 Diabetes Mellitus Using Layer-Specific Strain Analysis

Iso

Takahashi

Yazaki

et al. 2019

Circ J

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Background: Although the subclinical left ventricular (LV) dysfunction caused by diabetes mellitus (DM) results in a high risk of death and heart failure, the details of cardiac dysfunction across a wide age range remain unclear. The aim of this study was to assess LV dysfunction in patients with type 1 DM (T1DM) using layer-specific strain analysis by echocardiography. Methods and Results: The 52 patients (median age: 23 [range: 5-40] years) with T1DM were divided into 3 age groups (D1: 5-14 years, D2: 15-24 years, D3: 25-40 years); 78 age-and sex-similar controls were divided into 3 corresponding groups (C1, C2, and C3). Layer-specific longitudinal strain (LS) and circumferential strain (CS) of the 3 myocardial layers (endocardium, midmyocardium, and epicardium) were determined using echocardiography. Strains did not decrease in D1. Epicardial and midmyocardial CS at the basal level and LS in all layers were decreased in D2 compared with C2. CS at the basal level and LS in all layers were lower in D3 than in C3. The strains correlated with the duration of T1DM and LV wall thickness. Conclusions: In patients with T1DM, longitudinal deformation in all layers and epicardial and midmyocardial circumferential deformation at the basal level decreased from the late teens, which correlated with the duration of the disease and LV hypertrophy.

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“…This new, sensitive indicator is highly effective in detecting cardiac dysfunction in various cardiac diseases, including in children. [24][25][26][27]…”

Section: Primary Outcomementioning

confidence: 99%

Cardiac Function in Infants Born to Mothers With Gestational Diabetes　― Estimation of Early Diastolic Intraventricular Pressure Differences ―

et al. 2019

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prognostic value over conventional measures for predicting major adverse cardiac events. 6 Moreover, layer-specific myocardial strain can be measured in the endocardial, transmural, and epicardial left ventricular (LV) layers using this technique. 7 Further, intraventricular pressure differences (IVPD) and intraventricular pressure gradients (IVPG) can be measured on color M-mode imaging to accurately and non-invasively estimate active suction. 8-10 IVPD has an excellent correlation with Tau index, which is a gold standard, although Tau index is an invasive method of evaluating diastolic function. 11 In 2010, the International Association of Diabetes and Pregnancy Study Groups recommended new criteria for the diagnosis and classification of hyperglycemia during pregnancy, 12 recognizing the increasing prevalence of undi-G estational diabetes mellitus (GDM) increases the risk of numerous complications in the neonate, including both structural and functional cardiovascular disease. Infants, with structurally normal hearts, born to mothers with GDM (IGDM) may develop transient myocardial hypertrophy and associated systolic and diastolic dysfunction. 1 When present, IGDM with hypertrophic cardiomyopathy (HCM) tends to spontaneously regress in the first few months of life, 2 but asymptomatic IGDM without cardiac hypertrophy develop subclinical decreases in systolic and diastolic myocardial function. 3 Recently, new technology has been developed to estimate cardiac systolic and diastolic function, including 2-D speckle tracking echocardiography (2DST)-derived strain imaging. 4,5 Additionally, 2DST deformation imaging has superior Background: This study compared the myocardial performance of infants born to mothers with gestational diabetes mellitus (IGDM) and without GDM (controls) under the new GDM definitions. Methods and Results:The subjects consisted of 36 IGDM and 39 control infants. GDM diagnosis was based on oral glucose tolerance test during pregnancy or the presence of diabetes prior to the current pregnancy. Between-group infant cardiac function was determined and compared using 2-D speckle tracking analysis, intraventricular pressure difference (IVPD) and IVP gradient (IVPG), using color M-mode Doppler imaging. IVPD and IVPG were higher in IGDM than in the controls, particularly the mid-apical IVPG. The global circumferential strain (GCS) and endocardial GCS were higher in IGDM than in controls. Increased maternal glycated hemoglobin was correlated with reduced transmural and epicardial GCS in the IGDM. Maternal maximum fasting blood sugar had a mild, positive correlation with IVPD and IVPG. Conclusions:Ventricular sucking force, measured as the IVPD, IVPG, and endocardial GCS, were higher in IGDM than in the controls. A hyperglycemic environment during pregnancy leads to impaired cardiac performance in IGDM, compared with control infants. IGDM might have favorable systolic and diastolic cardiac performance due to cardiac metabolic adaptations occurring before poor glucose control causes impaired cardiac per...

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In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Childhood Cancer After Anthracycline Treatment Using Layer-Specific Strain Analysis

Cited by 20 publications

References 33 publications

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Type 1 Diabetes Mellitus Using Layer-Specific Strain Analysis

Cardiac Function in Infants Born to Mothers With Gestational Diabetes　― Estimation of Early Diastolic Intraventricular Pressure Differences ―

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In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Childhood Cancer After Anthracycline Treatment Using Layer-Specific Strain Analysis

Cited by 20 publications

References 33 publications

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

The early alteration of left ventricular strain and dys‐synchrony index in breast cancer patients undergoing anthracycline therapy using layer‐specific strain analysis

In-Depth Insight Into the Mechanisms of Cardiac Dysfunction in Patients With Type 1 Diabetes Mellitus Using Layer-Specific Strain Analysis

Cardiac Function in Infants Born to Mothers With Gestational Diabetes ― Estimation of Early Diastolic Intraventricular Pressure Differences ―

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Cardiac Function in Infants Born to Mothers With Gestational Diabetes　― Estimation of Early Diastolic Intraventricular Pressure Differences ―