Subclinical anthracycline‐induced cardiotoxicity in long‐term follow‐up of asymptomatic childhood cancer survivors: Assessment by speckle tracking echocardiography

Çetin, Süha; Babaoğlu, Kadir; Başar, Eviç Zeynep; Devecí, Murat; Çorapçıoğlu, Funda

doi:10.1111/echo.13743

Cited by 39 publications

(33 citation statements)

References 31 publications

(55 reference statements)

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“…26 Recently published study of Çetin et al also showed lower global longitudinal and radial strain values compared to control in asymptomatic childhood cancer survivors with normal left ventricle ejection fraction and fractional shortening. 27 Majority of these findings of two-dimensional speckle tracking analysis-based strain studies are consistent with the present study's result such as reduced global longitudinal and circumferential strain and strain rate values in survivors of childhood cancer compared to controls and negative impact of total anthracycline dose on the left ventricle function. Based on the recommended imaging surveillance frequencies in the long-term follow-up guidelines published by the Children's Oncology Group, patients were classified as high risk who had ≥ 300 mg/m 2 cumulative anthracycline dose at any age.…”

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confidence: 91%

Evaluation of long-term cardiac side effects of anthracycline chemotherapy by conventional and non-conventional echocardiographic methods in childhood cancer survivors

et al. 2019

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Objective:Anthracycline chemotherapeutic agents carry the well-recognised risk of cardiac toxicity. The aim of this study was to determine the long-term effect of anthracycline chemotherapy on the biventricular function in childhood cancer survivors using tissue Doppler imaging and two-dimensional speckle tracking echocardiography.Patients and Methods:The study included 45 survivors of childhood cancers and 50 healthy age-matched control patients. Cardiac function was prospectively studied with conventional echocardiography, tissue Doppler imaging, and speckle tracking echocardiography after completion of treatment. The same analysis was performed on matched controls.Results:There was no difference in age, gender, height, and weight between the study and control groups. The mean anthracycline dose was 240 ± 106 mg/m2 and the mean remission duration was 8.2 ± 5 years (1–20 years) in the study group. Conventional echocardiography showed similar ejection fraction, shortening fraction, and left ventricle end-diastolic diameter in both groups. Mitral lateral and septal tissue Doppler imaging showed normal but according to control group relatively sub-normal systolic and diastolic function in patient group. The global longitudinal and circumferential strain and strain rates were significantly lower in the patient group compared to control group. Correlation analysis revealed a negative and significant correlation between total anthracycline dose and global longitudinal and circumferential strain and strain rates.Conclusion:Sub-clinical systolic and diastolic dysfunction may not be detected by conventional echocardiographic methods which are frequently used in daily practice. Sub-clinical systolic and diastolic dysfunction may be detected more sensitively by echocardiographic method such as speckle tracking echocardiography in childhood cancer survivors.

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supporting

confidence: 91%

Evaluation of long-term cardiac side effects of anthracycline chemotherapy by conventional and non-conventional echocardiographic methods in childhood cancer survivors

et al. 2019

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“…Validation of LV longitudinal strain as a sensitive marker to detect early subclinical LV alterations in childhood cancer survivors remains to be demonstrated due to the lack of large-scale study. But in the recent years some small cohort studies have shown altered LV global longitudinal strain in adolescent and/or young adults with normal EF few months 37 , few years 38 , 39 and more than a decade 40 , 41 after chemotherapy. These studies corroborate our observations in our rodent model.…”

Section: Discussionmentioning

confidence: 99%

Screening for in-vivo regional contractile defaults to predict the delayed Doxorubicin Cardiotoxicity in Juvenile Rat

Chakouri¹,

Farah²,

Matecki³

et al. 2020

Theranostics

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Anthracyclines are key chemotherapeutic agents used in various adult and pediatric cancers, however, their clinical use is limited due to possible congestive heart failure (HF) caused by acute and irreversible cardiotoxicity. Currently, there is no method to predict the future development of the HF in these patients. In order to identify early biomarkers to predict anthracycline cardiotoxicity in long-term survivors of childhood cancer, this longitudinal study aimed to analyze early and late in-vivo regional myocardial anthracycline-induced cardiotoxicity, related to in-vitro cardiac myocytes dysfunction, in a juvenile rat model. Methods: Young male Wistar rats (4 weeks-old) were treated with different cumulative doses of doxorubicin (7.5, 10 or 12.5 mg/kg) or NaCl (0.9%) once a week for 6 weeks by intravenous injection. Cardiac function was evaluated in-vivo by conventional (left ventricular ejection fraction, LVEF) and regional two-dimensional (2D) speckle tracking echocardiography over the 4 months after the last injection. The animals were assigned to preserved (pEF) or reduced EF (rEF) groups at the end of the protocol and were compared to controls. Results: We observed a preferential contractile dysfunction of the base of the heart, further altered in the posterior segment, even in pEF group. The first regional alterations appeared 1 month after chemotherapy. Functional investigation of cardiomyocytes isolated from the LV base 1 month after doxorubicin treatment showed that early in-vivo contractile alterations were associated with both decreased myofilament Ca 2+ sensitivity and length-dependent activation. Changes in post-translational modifications (phosphorylation; S-glutathionylation) and protein degradation of the cardiac myosin binding protein-C may contribute to these alterations. Conclusion: Our data suggest that screening of the contractile defaults of the base of the heart by regional 2D strain echocardiography is useful to detect subclinical myocardial dysfunction prior to the development of delayed anthracycline-induced cardiomyopathy in pediatric onco-cardiology.

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“…42 Thus, strain imaging may be a powerful tool to identify early myocardial injury in survivors of childhood cancer. 45 Recently, three-dimensional echocardiography, especially three-dimensional strain imaging, has shown potential superiority in diagnosing subclinical cardiotoxicity in adult-onset cancers. 46 As an alternative to echocardiography, cMRI has been used to monitor early and late cardiotoxicity in paediatric cancer patients and survivors.…”

Section: Imagingmentioning

confidence: 99%

Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment

Chow

Leger

Bhatt

et al. 2019

Cardiovascular Research

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With 5-year survival of children with cancer exceeding 80% in developed countries, premature cardiovascular disease is now a major cause of early morbidity and mortality. In addition to the acute and chronic cardiotoxic effects of anthracyclines, related chemotherapeutics, and radiation, a growing number of new molecular targeted agents may also have detrimental effects on the cardiovascular system. Survivors of childhood cancer also may have earlier development of conventional cardiovascular risk factors such as hypertension, dyslipidaemia, and diabetes, which further increase their risk of serious cardiovascular disease. This review will examine the epidemiology of acute and chronic cardiotoxicity relevant to paediatric cancer patients, including genetic risk factors. We will also provide an overview of current screening recommendations, including the evidence regarding both imaging (e.g. echocardiography and magnetic resonance imaging) and blood-based biomarkers. Various primary and secondary prevention strategies will also be discussed, primarily in relation to anthracycline-related cardiomyopathy. Finally, we review the available evidence related to the management of systolic and diastolic dysfunction in paediatric cancer patients and childhood cancer survivors.

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Subclinical anthracycline‐induced cardiotoxicity in long‐term follow‐up of asymptomatic childhood cancer survivors: Assessment by speckle tracking echocardiography

Abstract: Despite normal EF and FS, children exposed to anthracycline therapy may have late-onset subtle changes of LV strain values measured by STE. Whether these changes of strain can predict future risk of developing heart failure needs to be explored in further studies.

Cited by 39 publications

References 31 publications

Evaluation of long-term cardiac side effects of anthracycline chemotherapy by conventional and non-conventional echocardiographic methods in childhood cancer survivors

Evaluation of long-term cardiac side effects of anthracycline chemotherapy by conventional and non-conventional echocardiographic methods in childhood cancer survivors

Screening for in-vivo regional contractile defaults to predict the delayed Doxorubicin Cardiotoxicity in Juvenile Rat

Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment

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