Portal de Periódicos da CAPES

Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer

2015; Elsevier BV; Volume: 65; Issue: 23 Linguagem: Inglês

10.1016/j.jacc.2015.04.013

1558-3597

Gregory T. Armstrong, Vijaya M. Joshi, Kirsten K. Ness, Thomas H. Marwick, Nan Zhang, Deo Kumar Srivastava, Brian P. Griffin, Richard A. Grimm, James D. Thomas, Dermot Phelan, Patrick Collier, Kevin R. Krull, Daniel A. Mulrooney, Daniel M. Green, Melissa M. Hudson, Leslie L. Robison, Juan Carlos Plana,

Cardiovascular Function and Risk Factors

Treatment-related cardiac death is the primary, noncancer cause of mortality in adult survivors of childhood malignancies. Early detection of cardiac dysfunction may identify a high-risk subset of survivors for early intervention.This study sought to determine the prevalence of cardiac dysfunction in adult survivors of childhood malignancies.Echocardiographic assessment included 3-dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential myocardial strain, and diastolic function, graded per American Society of Echocardiography guidelines in 1,820 adult (median age 31 years; range: 18 to 65 years) survivors of childhood cancer (median time from diagnosis 23 years; range: 10 to 48 years) exposed to anthracycline chemotherapy (n = 1,050), chest-directed radiotherapy (n = 306), or both (n = 464).Only 5.8% of survivors had abnormal 3D LVEFs ( 30 Gy (RR: 2.39; 95% CI: 1.79 to 3.18) and anthracycline dose > 300 mg/m(2) (RR: 1.72; 95% CI: 1.31 to 2.26). Survivors with metabolic syndrome were twice as likely to have abnormal global longitudinal strain (RR: 1.94; 95% CI: 1.66 to 2.28) and abnormal diastolic function (RR: 1.68; 95% CI: 1.39 to 2.03) but not abnormal 3D LVEFs (RR: 1.07; 95% CI: 0.74 to 1.53).Abnormal global longitudinal strain and diastolic function are more prevalent than reduced 3D LVEF and are associated with treatment exposure. They may identify a subset of survivors at higher risk for poor clinical cardiac outcomes who may benefit from early medical intervention.