Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
Department of Pediatrics, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-Shi, Chiba-Ken, 279-0021, Japan.
Heart Vessels. 2024 Feb;39(2):105-116. doi: 10.1007/s00380-023-02312-2. Epub 2023 Nov 16.
Cardiac dysfunction due to cardiotoxicity from anthracycline chemotherapy is a leading cause of morbidity and mortality in childhood cancer survivors (CCS), and the cumulative incidence of cardiac events has continued to increase. This study identifies an adequate indicator of cardiac dysfunction during long-term follow-up.
In total, 116 patients (median age: 15.5 [range: 4.7-40.2] years) with childhood cancer who were treated with anthracycline were divided into three age groups for analysis (C1: 4-12 years of age, C2: 13-18 years of age, C3: 19-40 years of age), and 116 control patients of similar ages were divided into three corresponding groups (N1, N2, and N3). Layer-specific strains were assessed for longitudinal strain (LS) and circumferential strain (CS). The total and segmental intraventricular pressure gradients (IVPG) were also calculated based on Doppler imaging of the mitral inflow using Euler's equation.
Conventional echocardiographic parameters were not significantly different between the patients and controls. All layers of the LS and inner and middle layers of the basal and papillary CS in all ages and all IVPGs in C2 and C3 decreased compared to those of corresponding age groups. Interestingly, basal CS and basal IVPG in CCS showed moderate correlation and both tended to rapidly decrease with aging. Furthermore, basal IVPG and anthracycline dose showed significant correlations.
Basal CS and total and basal IVPGs may be particularly useful indicators of cardiotoxicity in long-term follow-up.
蒽环类化疗引起的心脏毒性导致的心脏功能障碍是儿童癌症幸存者（CCS）发病率和死亡率的主要原因，并且心脏事件的累积发生率持续增加。本研究旨在确定长期随访期间心脏功能障碍的适当指标。
共纳入 116 例接受蒽环类药物治疗的儿童癌症患者（中位年龄：15.5 岁[范围：4.7-40.2 岁]），并根据年龄分为三组进行分析（C1：4-12 岁，C2：13-18 岁，C3：19-40 岁），另外选取了 116 例年龄匹配的对照组患者分为三组（N1、N2 和 N3）。评估了层特异性应变的纵向应变（LS）和环向应变（CS）。还根据二尖瓣流入多普勒成像使用欧拉方程计算了总和节段性室内压力梯度（IVPG）。
患者与对照组的常规超声心动图参数无显著差异。与相应年龄组相比，所有年龄组的 LS 各层和 CS 的内层和中层以及基底和乳头肌 CS 的基底段均降低，并且 C2 和 C3 中的所有 IVPG 均降低。有趣的是，CCS 的基底 CS 和基底 IVPG 显示出中度相关性，并且两者均随年龄的增长而迅速下降。此外，基底 IVPG 与蒽环类药物剂量之间存在显著相关性。
基底 CS 和总 IVPG 以及基底 IVPG 可能是长期随访中心脏毒性的特别有用的指标。
