Niemelä Jussi, Ylänen Kaisa, Suominen Anu, Pushparajah Kuberan, Mathur Sujeev, Sarkola Taisto, Jahnukainen Kirsi, Eerola Anneli, Poutanen Tuija, Vettenranta Kim, Ojala Tiina
Department of Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland.
Front Cardiovasc Med. 2021 Oct 18;8:715953. doi: 10.3389/fcvm.2021.715953. eCollection 2021.
The majority of childhood cancer survivors (CCSs) have been exposed to cardiotoxic treatments and often present with modifiable cardiovascular risk factors. Our aim was to evaluate the value of left ventricular (LV) longitudinal strain for increasing the sensitivity of cardiac dysfunction detection among CCSs. We combined two national cohorts: neuroblastoma and other childhood cancer survivors treated with anthracyclines. The final data consisted of 90 long-term CCSs exposed to anthracyclines and/or high-dose chemotherapy with autologous stem cell rescue and followed up for > 5 years and their controls ( = 86). LV longitudinal strain was assessed with speckle tracking (Qlab) and LV ejection fraction (EF) by three-dimensional echocardiography (3DE). Of the CCSs, 11% (10/90) had abnormal LV longitudinal strain (i.e., < -17.5%); of those, 70% (7/10) had normal 3DE LV EF. Multivariable linear model analysis demonstrated that follow-up time ( = 0.027), sex ( = 0.020), and BMI ( = 0.002) were significantly associated with LV longitudinal strain. Conversely, cardiac risk group, hypertension, age, cumulative anthracycline dose or exposure to chest radiation were not. LV longitudinal strain is a more sensitive method than LV EF for the detection of cardiac dysfunction among CCSs. Therefore, LV longitudinal strain should be added to the screening panel, especially for those with modifiable cardiovascular risk factors.
大多数儿童癌症幸存者（CCSs）都接受过心脏毒性治疗，且常常存在可改变的心血管危险因素。我们的目的是评估左心室（LV）纵向应变对于提高CCSs中心脏功能障碍检测敏感性的价值。我们合并了两个全国性队列：接受蒽环类药物治疗的神经母细胞瘤幸存者和其他儿童癌症幸存者。最终数据包括90名长期接受蒽环类药物和/或高剂量化疗并进行自体干细胞救援且随访超过5年的CCSs及其对照组（n = 86）。通过斑点追踪（Qlab）评估LV纵向应变，并通过三维超声心动图（3DE）评估LV射血分数（EF）。在CCSs中，11%（10/90）的患者LV纵向应变异常（即< -17.5%）；其中，70%（7/10）的患者3DE LV EF正常。多变量线性模型分析表明，随访时间（P = 0.027）、性别（P = 0.020）和BMI（P = 0.002）与LV纵向应变显著相关。相反，心脏风险组、高血压、年龄、蒽环类药物累积剂量或胸部放疗暴露则无相关性。对于检测CCSs中的心脏功能障碍，LV纵向应变是比LV EF更敏感的方法。因此，LV纵向应变应添加到筛查项目中，尤其是对于那些存在可改变心血管危险因素的患者。
