title: Cardiac Outcomes in Adult Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy: A Cross-sectional Study.
abstract: BACKGROUND
  Studies of cardiac disease among adult survivors of childhood cancer have generally relied on self-reported or registry-based data.
  
  
  OBJECTIVE
  To systematically assess cardiac outcomes among survivors of childhood cancer.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  St. Jude Children's Research Hospital.
  
  
  METHODS
  1853 adult survivors of childhood cancer, aged 18 years or older, who received cancer-related cardiotoxic therapy at least 10 years earlier.
  
  
  METHODS
  Baseline history and physical examination, fasting metabolic and lipid panels, echocardiography, electrocardiography, and 6-minute walk test.
  
  
  RESULTS
  One half of the survivors (52.3%) were men with a median age of 8 years (range, 0 to 24 years) at cancer diagnosis and 31 years (range, 18 to 60 years) at evaluation. Cardiomyopathy was present in 7.4% survivors (newly identified at the time of evaluation in 4.7%), coronary artery disease in 3.8% (newly identified in 2.2%), valvular regurgitation or stenosis in 28.0% (newly identified in 24.8%), and conduction or rhythm abnormalities in 4.4% (newly identified in 1.4%). Nearly all survivors were asymptomatic. The prevalence of cardiac conditions increased with age at evaluation, ranging from 3% to 24% among survivors aged 30 to 39 years to 10% to 37% among those aged 40 years or older. In multivariable analysis, survivors exposed to anthracycline doses of 250 mg/m2 or more had greater odds of cardiomyopathy (odds ratio, 2.7 [95% CI, 1.1 to 6.9]) than those who were not exposed. Survivors exposed to heart radiation also had increased odds of cardiomyopathy (odds ratio, 1.9 [CI, 1.1 to 3.7]) compared with those who were not exposed. Radiation exposure greater than 1500 cGy with any anthracycline exposure conferred the greatest odds for valve findings.
  
  
  CONCLUSIONS
  Sixty-one percent of survivors exposed to anthracycline chemotherapy or cardiac-directed radiation participated. A comparison group and longitudinal assessments were not available.
  
  
  CONCLUSIONS
  Cardiovascular screening identified considerable subclinical disease among adult survivors of childhood cancer.
  
  
  BACKGROUND
  National Cancer Institute, American Lebanese Syrian Associated Charities.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Mulrooney
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Sujuan
authors.initials: S
authors.lastname: Huang
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Ehrhardt
authors.forename: Vijaya M
authors.initials: VM
authors.lastname: Joshi
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Plana
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.forename: Aimee
authors.initials: A
authors.lastname: Santucci
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Krasin
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects*; D054715:Cardiotoxins / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D015995:Prevalence; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D017741:Survivors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D054715:Cardiotoxins