儿童癌症长期随访中的高级影像学和新型心脏生物标志物。

Advanced Imaging and New Cardiac Biomarkers in Long-term Follow-up After Childhood Cancer.

机构信息

Department of Paediatric Cardiology, Heart Center.

Division of Clinical Chemistry and Biochemistry.

出版信息

J Pediatr Hematol Oncol. 2022 Mar 1;44(2):e374-e380. doi: 10.1097/MPH.0000000000002156.

DOI:10.1097/MPH.0000000000002156

PMID:33828032

Abstract

OBJECTIVES

Pathologic ejection fraction (EF), shortening fraction (FS), and standard heart failure biomarkers (high sensitive troponin T and N-terminal brain natriuretic peptide) during follow-up after childhood cancer have been associated with irreversible cardiac damage. We aimed to evaluate strain imaging values by echocardiography and new biomarkers for heart failure with preserved ejection fraction (HFpEF) as potential more sensitive parameters for cardiac deterioration in childhood cancer survivors (CCS).

MATERIALS AND METHODS

Prospective study with 50 CCS (median 16.2 y) at a median follow-up of 13 years. In addition to standard echo and laboratory parameters for heart failure, strain measurements and new biomarkers, including myocardial inflammation (interleukin 6), extracellular matrix (ECM) remodeling (C-telopeptide for type I collagen, intact N-terminal propeptide of type III procollagen), and other heart failure biomarkers (galectin 3, solutable ST2, growth differentiation factor 15), were obtained and compared with 50 healthy controls.

RESULTS

No significant differences in EF, FS, high sensitive troponin T, N-terminal brain natriuretic peptide, interleukin 6, solutable ST2, and galectin 3 were found between study and control groups. In contrast, strain imaging showed significant differences between both groups (global longitudinal strainGLS -16.1% vs. -20.4%, P<0.0001; global circumferential strain -14.3 vs. -21.4%, P<0.0001), detecting 66% (global longitudinal strain) and 76% (global circumferential strain) of patients with pathologic values in contrast to 6% (EF) and 16% (FS) for standard parameters. Markers for disturbances of ECM remodeling (C-telopeptide for type I collagen, intact N-terminal propeptide of type III procollagen, each P<0.0001) and growth differentiation factor 15 (P<0.0001) were significantly different between the groups.

CONCLUSION

Strain imaging and new cardiac biomarkers used in HFpEF focusing on ECM remodeling appear to be more sensitive in detecting early remodeling processes in CCS than standard echo and laboratory parameters.

摘要

目的

在儿童癌症后随访期间，病理性射血分数（EF）、缩短分数（FS）和标准心力衰竭生物标志物（高敏肌钙蛋白 T 和 N 末端脑利钠肽）与不可逆性心脏损伤有关。我们旨在通过超声心动图评估应变成像值和新的心力衰竭保留射血分数（HFpEF）生物标志物，以作为儿童癌症幸存者（CCS）心脏恶化的潜在更敏感参数。

材料和方法

前瞻性研究，纳入 50 名 CCS（中位数 16.2 岁），中位随访时间为 13 年。除了心力衰竭的标准超声心动图和实验室参数外，还获得了应变测量和新的生物标志物，包括心肌炎症（白细胞介素 6）、细胞外基质（ECM）重塑（I 型胶原 C-端肽，III 型前胶原完整 N 端肽）和其他心力衰竭生物标志物（半乳糖凝集素 3、可溶性 ST2、生长分化因子 15），并与 50 名健康对照进行比较。

结果

研究组和对照组之间 EF、FS、高敏肌钙蛋白 T、N 末端脑利钠肽、白细胞介素 6、可溶性 ST2 和半乳糖凝集素 3 无显著差异。相比之下，两组之间的应变成像存在显著差异（整体纵向应变 GLS -16.1%与-20.4%，P<0.0001；整体周向应变-14.3%与-21.4%，P<0.0001），检测到 66%（整体纵向应变）和 76%（整体周向应变）患者的病理性值，而标准参数的检测率分别为 6%（EF）和 16%（FS）。I 型胶原 C-端肽、III 型前胶原完整 N 端肽（均 P<0.0001）和生长分化因子 15（P<0.0001）的 ECM 重塑标志物在两组之间存在显著差异。