title: Myocardial stiffness as assessed by diastolic wall strain in adult survivors of childhood leukaemias with preserved left ventricular ejection fraction.
abstract: OBJECTIVE
  We tested the hypothesis that myocardial stiffness as assessed by diastolic wall strain (DWS) is altered in adult survivors of childhood leukaemias with preserved left ventricular (LV) ejection fraction and explored its association with myocardial fibrosis and diastolic deformation.
  
  
  RESULTS
  Ninety-four (53 males) adult survivors of childhood leukaemias aged 22.2 ± 5.5 years and 66 (36 males) healthy controls were studied retrospectively. Diastolic wall strain and calibrated integrated backscatter (cIB) were measured as indices of myocardial stiffness and fibrosis, respectively. Left and right ventricular (RV) diastolic and torsional mechanics were interrogated using speckle tracking echocardiography. Patients had significantly lower LV DWS, and hence stiffer LV myocardium, and greater myocardial cIB in patients than controls (all P < 0.001). Left ventricular longitudinal, radial, and circumferential early diastolic strain rates, circumferential late diastolic strain rate, and peak twisting and untwisting velocities, tricuspid annular early diastolic velocity, and RV-free wall longitudinal early diastolic strain rate were significantly lower in patients than controls (all P < 0.05). Diastolic wall strain correlated inversely with myocardial cIB, and positively with LV longitudinal, radial, and circumferential early diastolic strain rates (all P < 0.05), while myocardial cIB correlated inversely with LV radial and circumferential early diastolic strain rates, circumferential late diastolic strain rate, peak twisting and untwisting velocities, and tricuspid annular e velocity (all P < 0.05).
  
  
  CONCLUSIONS
  In adult survivors of childhood leukaemias, despite the preservation of LV ejection fraction, increased stiffness of the LV myocardium is evident and is associated with myocardial fibrosis and impaired ventricular diastolic function.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Vivian Wing-Yi
authors.initials: VW
authors.lastname: Li
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Daniel Ka-Leung
authors.initials: DK
authors.lastname: Cheuk
authors.affiliation: Department of Paediatrics, Prince of Wales Hospital, Sha Tin, Hong Kong.
authors.forename: Frankie Wai-Tsoi
authors.initials: FW
authors.lastname: Cheng
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Janet Yee-Kwan
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Department of Paediatrics, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong.
authors.forename: Jeffrey Ping-Wa
authors.initials: JP
authors.lastname: Yau
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong.
authors.forename: Karin Ka-Huen
authors.initials: KK
authors.lastname: Ho
authors.affiliation: Department of Paediatrics, Prince of Wales Hospital, Sha Tin, Hong Kong.
authors.forename: Chi-Kong
authors.initials: CK
authors.lastname: Li
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong.
authors.forename: Rever Chak-Ho
authors.initials: RC
authors.lastname: Li
authors.affiliation: Department of Paediatrics, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong.
authors.forename: Hui-Leung
authors.initials: HL
authors.lastname: Yuen
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Kwai Chung, Hong Kong.
authors.forename: Alvin Siu-Cheung
authors.initials: AS
authors.lastname: Ling
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Godfrey Chi-Fung
authors.initials: GC
authors.lastname: Chan
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Yiu-Fai
authors.initials: YF
authors.lastname: Cheung
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003971:Diastole / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009206:Myocardium / Q000473:pathology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D017741:Survivors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
keywords: Childhood leukaemia survivors; Diastolic function; Diastolic wall strain; Myocardial stiffness