Akam-Venkata Jyothsna, Kadiu Gilda, Galas James, Lipshultz Steven E, Aggarwal Sanjeev
Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
Division of Cardiology, Children's Hospital of Michigan, Detroit, MI, USA.
Cardiol Young. 2019 Dec;29(12):1494-1500. doi: 10.1017/S1047951119002622. Epub 2019 Nov 27.
Anthracycline-associated cardiotoxicity in childhood cancer survivors may relate to global or segmental left ventricular abnormalities from associated thromboembolic events and myocardial microinfarcts. We characterized left ventricular segmental changes by two-dimensional speckle-tracking echocardiography in anthracycline-treated asymptomatic childhood cancer survivors.
Childhood cancer survivors' echocardiograms with normal left ventricular fractional shortening >1 year after anthracycline chemotherapy were studied. Cancer-free control children had normal echocardiograms. Apical two-, three-, and four-chamber peak systolic left ventricular longitudinal and global longitudinal strain, and peak systolic left ventricular radial and circumferential strain at papillary muscle levels were analyzed. The mean (standard deviation) age was 12.7 (3.8) years in 41 childhood cancer survivors. The median (interquartile range) follow-up after anthracycline chemotherapy was 4.73 (2.15-8) years. The median (range) cumulative anthracycline dose was 160.2 (60-396.9) mg/m2. In childhood cancer survivors, the mean (standard deviation) left ventricular longitudinal strain was lower in two- (-18.6 [3.2] versus -21.3 [2.5], p < 0.001), three- (-16.3 [6.0] versus -21.7 [3.0], p < 0.001), and four- (-17.6 [2.7] versus -20.8 [2.0], p < 0.001) chamber views compared to controls. The left ventricular global longitudinal strain (-17.6 [2.7] versus -21.3 [2.0]) and circumferential strain (-20.8 [4.3] versus -23.5 [2.6], p < 0.001) were lower in childhood cancer survivors. Among childhood cancer survivors, 12 out of 16 left ventricular segments had significantly lower longitudinal strain than controls.
Asymptomatic anthracycline-treated childhood cancer survivors with normal left ventricular fractional shortening had lower global longitudinal and circumferential strain. The left ventricular longitudinal strain was lower in majority of the segments, suggesting that anthracycline cardiotoxicity is more global than regional.
儿童癌症幸存者中蒽环类药物相关的心脏毒性可能与相关血栓栓塞事件和心肌微梗死导致的左心室整体或节段性异常有关。我们采用二维斑点追踪超声心动图对接受蒽环类药物治疗的无症状儿童癌症幸存者的左心室节段变化进行了特征分析。
对蒽环类药物化疗1年以上且左心室缩短分数正常的儿童癌症幸存者的超声心动图进行了研究。无癌症的对照儿童超声心动图正常。分析了心尖两腔、三腔和四腔的左心室收缩期峰值纵向应变和整体纵向应变，以及乳头肌水平的左心室收缩期峰值径向应变和圆周应变。41名儿童癌症幸存者的平均（标准差）年龄为12.7（3.8）岁。蒽环类药物化疗后的中位（四分位间距）随访时间为4.73（2.15 - 8）年。累积蒽环类药物剂量的中位（范围）值为160.2（60 - 396.9）mg/m²。在儿童癌症幸存者中，两腔（-18.6 [3.2] 对 -21.3 [2.5]，p < 0.001）、三腔（-16.3 [6.0] 对 -21.7 [3.0]，p < 0.001）和四腔（-17.6 [2.7] 对 -20.8 [2.0]，p < 0.001）视图中的左心室纵向应变平均值低于对照组。儿童癌症幸存者的左心室整体纵向应变（-17.6 [2.7] 对 -21.3 [2.0]）和圆周应变（-20.8 [4.3] 对 -23.
