Three-dimensional echocardiography and cardiac magnetic resonance imaging in the screening of long-term survivors of childhood cancer after cardiotoxic therapy.
The left ventricular (LV) volumes, ejection fraction (EF), and dyssynchrony indexes for the 16 and 12 cardiac segments (Tmsv16-SD and Tmsv12-SD, respectively) were analyzed among nonadult, anthracycline-exposed long-term survivors of childhood cancer and compared with those of healthy controls using conventional and real-time 3-dimensional echocardiography (RT-3DE) with cardiac magnetic resonance (CMR) imaging in a prospective, cross-sectional, single tertiary center setting. Seventy-one survivors and gender-, body surface area-, and age-matched healthy controls were studied by conventional echocardiography and RT-3DE. Fifty-eight of the 71 survivors underwent also CMR. The survivors were evaluated in 2 groups. Group I consisted of 63 exposed to anthracyclines and group II consisted of 8 also exposed to cardiac irradiation. By RT-3DE, the group I survivors had a lower LVEF (57% vs 60%, respectively, p = 0.003) and larger body surface area-indexed LV end-systolic volume (31 vs 28 ml/m(2), respectively, p = 0.001) than controls. The Tmsv16-SD was higher in group II than in I (1.93% vs 1.39%, respectively, p = 0.003). None of the survivors had an abnormal fractional shortening (<28%), but 10% had an LVEF <50% by RT-3DE. An LVEF <55% was detected in 45 of 58 (78%) of those imaged with CMR. In conclusion, RT-3DE seems to detect more abnormalities in cardiac function than conventional echocardiography following childhood cancer therapy. The LV dyssynchrony indexes derived from RT-3DE appear potentially useful in assessing the early signs of cardiotoxicity between anthracycline and cardiac irradiation exposed long-term survivors of childhood cancer.
Department of Pediatrics, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland. Electronic address: kaisa@ylanen.fi.
Kaisa
K
Ylänen
Department of Pediatrics, Tampere University Hospital, Tampere, Finland.
Anneli
A
Eerola
Hospital for Children and Adolescents, Helsinki, Finland; University of Helsinki, Helsinki, Finland.
Kim
K
Vettenranta
Department of Pediatrics, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere, Finland.
Tuija
T
Poutanen
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003430:Cross-Sectional Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D015994:Incidence; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009369:Neoplasms / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D017741:Survivors; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology
D000970:Antineoplastic Agents