Myocardial Deformation Imaging by Speckle-Tracking Echocardiography for Assessment of Cardiotoxicity in Children during and after Chemotherapy: A Systematic Review and Meta-Analysis

Li, Vivian Wing‐yi; So, Edwina Kam-fung; Wong, Wilfred Hing‐Sang; Cheung, Yiu‐fai

doi:10.1016/j.echo.2022.01.017

Cited by 9 publications

(7 citation statements)

References 75 publications

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“…47,48 Survivors also have an increased rates of hypertension, dyslipidemia, and vascular disease compared with the general population that may be exacerbated by environmental exposures and behaviors such as exercise, diet, and tobacco use. [42][43][44][45][46][47][48] Because of the inherent challenges faced by many childhood cancer survivors, who often are faced with strong desires to minimize medical care and to reflect peers without cancer histories, we suggest that an enhanced focus on the need for consistent care should be delivered to both patients and facilities.…”

Section: Cardiotoxicity In Pediatric Populationsmentioning

confidence: 99%

“…42,43 Cardiac studies in survivors have demonstrated frequent functional abnormalities by echocardiogram, including abnormal myocardial strain both early after therapy and over longer-term follow-up, even in the absence of symptoms. 45,46 Exercise stress testing has also shown progressive decline in measured exercise capacity (peak V o 2 ). 47,48 Survivors also have an increased rates of hypertension, dyslipidemia, and vascular disease compared with the general population that may be exacerbated by environmental exposures and behaviors such as exercise, diet, and tobacco use.…”

Section: Population-specific Considerationsmentioning

confidence: 99%

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Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association

Morrison¹,

Baik²,

Fradley³

et al. 2023

Circulation

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Advances in cancer therapeutics have revolutionized survival outcomes in patients with cancer. However, cardiovascular toxicities associated with specific cancer therapeutics adversely affect the outcomes of patients with cancer. Recent studies have uncovered excess risks of these cardiotoxic events, especially in traditionally underrepresented populations. Despite advances in strategies to limit the risks of cardiovascular events among cancer survivors, relatively limited guidance is available to address the rapidly growing problem of disparate cardiotoxic risks among women and underrepresented patient populations. Previously decentralized and sporadic evaluations have led to a lack of consensus on the definitions, investigation, and potential optimal strategies to address disparate cardiotoxicity in contemporary cancer care (eg, with immunotherapy, biologic, or cytotoxic therapies) settings. This scientific statement aims to define the current state of evidence for disparate cardiotoxicity while proposing uniform and novel methodological approaches to inform the identification and mitigation of disparate cardio-oncology outcomes in future clinical trials, registries, and daily clinical care settings. We also propose an evidence-based integrated approach to identify and mitigate disparities in the routine clinical setting. This consensus scientific statement summarizes and clarifies available evidence while providing guidance on addressing inequities in the era of emerging anticancer therapies.

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Section: Cardiotoxicity In Pediatric Populationsmentioning

confidence: 99%

Section: Population-specific Considerationsmentioning

confidence: 99%

Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association

Morrison¹,

Baik²,

Fradley³

et al. 2023

Circulation

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show abstract

“…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 ]. In the present study, we aimed to describe the incidence of cardiac events in CCS during long-term follow-up, a decade after an index echocardiography was made that included strain measurement.…”

Section: Introductionmentioning

confidence: 99%

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

Pourier

Merkx²,

Loonen

et al. 2022

Life

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In echocardiographic surveillance of anthracycline-treated childhood cancer survivors (CCS), left ventricular ejection fraction (LVEF) has insufficient prognostic value for future cardiac events, whereas longitudinal strain may be more sensitive. We describe the long-term incidence of cardiac events in CCS after previous measurement of LVEF and myocardial strain. Echocardiography, including four-chamber view longitudinal strain (4CH-LS), of 116 anthracycline-treated CCS was obtained between 2005–2009 (index echocardiography). Follow-up was obtained at the late-effects clinic. Primary outcome was occurrence of cardiac events, defined as either symptomatic heart failure, life-threatening arrhythmias, LVEF < 40% or cardiac death, in CCS with normal versus abnormal index 4CH-LS. LVEF from subsequent echocardiograms was obtained to evaluate its natural course as a secondary outcome. After index echocardiography (median 13.1 years since childhood cancer diagnosis), our study added a median follow-up of 11.3 years (median last clinical contact 23.6 years since diagnosis). Only three CCS developed a cardiac event (6.2, 6.4 and 6.7 years after index echocardiography), resulting in a ten-year cumulative incidence of 2.7% (95%CI 0.9–8.2). All three CCS had a clearly reduced index 4CH-LS and relevant cardiovascular risk factors, whereas their index LVEFs were around the lower limit of normal. Index LVEF correlated with index 4CH-LS but mean long-term natural course of LVEF was comparable for CCS with abnormal versus normal index 4CH-LS. Absolute 10-year cumulative incidence of cardiac events in anthracycline-treated CCS during long-term follow-up was low. Sensitive echocardiographic measurements, such as 4CH-LS may be useful to tailor surveillance frequency in a selected group of CCS without cardiovascular disease.

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“… 28 We and others have reported on the high reproducibility of strain measurements in children during and after chemotherapy and have summarized the reproducibility measurements in our recent systematic review. 29 For the measurements of global LV longitudinal systolic strain, systolic strain rate, and early and late diastolic strain rates, the intraobserver variability was 4.3%, 5.1%, 5.4%, and 5.7%, respectively, whereas the interobserver variability was 6.9%, 5.4%, 6.0%, and 7.0%, respectively. Clinical cardiovascular events included the development of heart failure and cardiac arrhythmias, the need to institute cardiac medications, and cardiac death.…”

Section: Methodsmentioning

confidence: 88%

Remote Ischemic Conditioning in Pediatric Cancer Patients Receiving Anthracycline Chemotherapy

Cheung¹,

Li²,

So³

et al. 2023

JACC: CardioOncology

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Myocardial Deformation Imaging by Speckle-Tracking Echocardiography for Assessment of Cardiotoxicity in Children during and after Chemotherapy: A Systematic Review and Meta-Analysis

Cited by 9 publications

References 75 publications

Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association

Equity in Cardio-Oncology Care and Research: A Scientific Statement From the American Heart Association

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

Remote Ischemic Conditioning in Pediatric Cancer Patients Receiving Anthracycline Chemotherapy

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