儿童分化型甲状腺癌幸存者的进展性舒张功能障碍。

Progressive diastolic dysfunction in survivors of pediatric differentiated thyroid carcinoma.

机构信息

Department of Endocrinology, University of Groningen, University Medical Center Groningen, Internal Medicine, Groningen, the Netherlands.

University of Groningen, Beatrix Children's Hospital, Paediatric Oncology, University Medical Center Groningen, Groningen, Groningen.

出版信息

Eur J Endocrinol. 2022 Sep 12;187(4):497-505. doi: 10.1530/EJE-22-0094. Print 2022 Oct 1.

DOI:10.1530/EJE-22-0094

PMID:35947635

Abstract

BACKGROUND

Pediatric differentiated thyroid cancer (DTC) has an excellent prognosis but unknown late effects of treatment. The initial cardiac evaluation showed subclinical diastolic dysfunction in 20% of adult survivors. The objective of this follow-up study was to determine the clinical course of this finding.

METHODS

This multicenter study, conducted between 2018 and 2020, re-evaluated survivors after 5 years. The primary endpoint was echocardiographic diastolic cardiac function (depicted by the mean of the early diastolic septal and early diastolic lateral tissue velocity (e' mean)). Secondary endpoints were other echocardiographic parameters and plasma biomarkers.

RESULTS

Follow-up evaluation was completed in 47 (71.2%) of 66 survivors who had completed their initial evaluation. Of these 47 survivors, 87.2% were women. The median age was 39.8 years (range: 18.8-60.3), and the median follow-up after the initial diagnosis was 23.4 years (range: 10.2-48.8). Between the first and second evaluation, the e' mean significantly decreased by 2.1 cm/s (s.d. 2.3 cm/s, P < 0.001). The median left ventricular ejection fraction did not significantly change (58.0% vs 59.0%, P= NS). In the best explanatory model of e' mean, multivariate linear regression analysis showed that BMI and age were significantly associated with e' mean (β coefficient: -0.169, 95% CI: -0.292; -0.047, P = 0.008 and β coefficient: -0.177, 95% CI: -0.240; -0.113, P < 0.001, respectively).

CONCLUSIONS AND RELEVANCE

In these relatively young survivors of pediatric DTC, diastolic function decreased significantly during 5-year follow-up and is possibly more pronounced than in normal aging. This finding requires further follow-up to assess clinical consequences.

摘要

背景

儿科分化型甲状腺癌（DTC）具有极好的预后，但治疗的未知晚期影响尚不清楚。在成年幸存者中，20%的人在初始心脏评估中显示出亚临床舒张功能障碍。本随访研究的目的是确定这一发现的临床过程。

方法

这项多中心研究于 2018 年至 2020 年进行，对 5 年后的幸存者进行了重新评估。主要终点是超声心动图舒张心脏功能（由舒张早期间隔和舒张早期侧壁组织速度的平均值（e'mean）表示）。次要终点是其他超声心动图参数和血浆生物标志物。

结果

在完成初始评估的 66 名幸存者中，有 47 名（71.2%）完成了随访评估。这些幸存者中，87.2%为女性。中位年龄为 39.8 岁（范围：18.8-60.3），初始诊断后中位随访时间为 23.4 年（范围：10.2-48.8）。在第一次和第二次评估之间，e'mean 显著下降 2.1cm/s（标准差 2.3cm/s，P<0.001）。左心室射血分数的中位数没有明显变化（58.0%比 59.0%，P=NS）。在 e'mean 的最佳解释模型中，多元线性回归分析显示 BMI 和年龄与 e'mean 显著相关（β系数：-0.169，95%置信区间：-0.292；-0.047，P=0.008 和 β系数：-0.177，95%置信区间：-0.240；-0.113，P<0.001）。