title: Association between right ventricular dysfunction and restrictive lung disease in childhood cancer survivors as measured by quantitative echocardiography.
abstract: BACKGROUND
  Restrictive lung disease is a complication in childhood cancer survivors who received lung-toxic chemotherapy and/or thoracic radiation. Left ventricular dysfunction is documented in these survivors, but less is known about right ventricular (RV) function. Quantitative echocardiography may help detect subclinical RV dysfunction. The aim of this study was to assess RV function quantitatively in childhood cancer survivors after lung-toxic therapy.
  
  
  METHODS
  We identified records of 33 childhood cancer survivors who (1) were treated with lung-toxic therapy and/or radiation, (2) were cancer-free for ≥ one year after therapy, and (3) had pulmonary function tests and echocardiograms from their most recent follow-up visit.
  
  
  RESULTS
  Participants' mean age was 11.6 ± 4.5 years at cancer diagnosis and 23 ± 8.6 years at evaluation. The most common diagnosis was lymphoma/leukemia (n = 27). Twenty-nine subjects had anthracycline exposure. Eleven of the 33 subjects demonstrated restrictive pulmonary impairment (total lung capacity 3.69 ± 1.5 L [69.3 ± 22.4% predicted]). Among quantitative measures of RV function, isovolumetric acceleration (IVA), a measure of contractility, was significantly lower in the group with restrictive lung disease (2.42 ± 0.56 vs. 1.83 ± 0.78 m/sec(2); P < 0.05). There was a trend towards lower tissue Doppler derived S' and tricuspid annular plane systolic excursion in the group with restrictive lung disease. Subjects with restrictive lung disease were found to have ≥ 2 abnormal parameters (P < 0.01).
  
  
  CONCLUSIONS
  IVA may detect early RV dysfunction in childhood cancer survivors with restrictive lung disease. Our findings require confirmation in a larger study population and validation by cardiac MRI.
authors.affiliation: Section of Pediatric Respiratory Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Amee
authors.initials: A
authors.lastname: Patel
authors.forename: Constance
authors.initials: C
authors.lastname: Weismann
authors.forename: Pnina
authors.initials: P
authors.lastname: Weiss
authors.forename: Kerry
authors.initials: K
authors.lastname: Russell
authors.forename: Alia
authors.initials: A
authors.lastname: Bazzy-Asaad
authors.forename: Nina S
authors.initials: NS
authors.lastname: Kadan-Lottick
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D008297:Male; D009200:Myocardial Contraction; D009369:Neoplasms / Q000401:mortality*; D017741:Survivors; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*
keywords: cardiac; childhood cancer; late effects; pulmonary; right ventricular dysfunction; survivorship; tissue Doppler imaging