Utility of Global Longitudinal Strain by Echocardiography to Detect Left Ventricular Dysfunction in Long-Term Adult Survivors of Childhood Lymphoma and Acute Lymphoblastic Leukemia.
Measuring left ventricular (LV) global longitudinal strain (GLS) is recommended in screening of long-term cancer survivors for cardiotoxicity. However, there are limited data on GLS in this setting, in particular in survivors with apparently normal LV function without risk factors of impaired GLS. In the present study, we measured GLS in 191 adult survivors of childhood lymphoma or acute lymphoblastic leukemia, with normal LV ejection fraction and fractional shortening (FS) and without known hypertension, diabetes mellitus, myocardial infarction, or stroke. We compared GLS in the survivors with 180 controls. Mean GLS was -19.0 ± 2.2% in the survivor group and -21.4 ± 2.0% in the controls (p <0.001). Impaired GLS, defined as mean - 1.96 SDs in the control group, occurred in 53 of 191 survivors (28%). We included survivors with impaired LV ejection fraction and/or FS or traditional risk factors (n = 231 in all) in multiple regression analyses to explore associations with previous cancer treatment. Survivors treated with mediastinal radiotherapy had an odds ratio of impaired GLS of 5.2 (95% confidence interval 2.2 to 12) compared with other survivors. Survivors treated with cumulative anthracycline doses >300 mg/m(2) had an odds ratio of 4.8 (95% confidence interval 1.7 to 14) of impaired GLS. In conclusion, this study demonstrates a high proportion of LV dysfunction assessed by GLS in apparently healthy adult survivors of childhood cancer. Impaired GLS was associated with previous exposure to mediastinal radiotherapy and high doses of anthracyclines. The prognostic role of measuring GLS in this specific patient population should be examined in prospective studies.
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Medicine, Innlandet Hospital Trust, Elverum, Norway. Electronic address: jorch@online.no.
Jon R
JR
Christiansen
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Richard
R
Massey
Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Håvard
H
Dalen
Department of Pediatric Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Adriani
A
Kanellopoulos
National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; Department of Oncology, Akershus University Hospital, Lørenskog, Norway.
Hanne
H
Hamre
National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; Cancer Registry of Norway, Oslo, Norway.
Sophie D
SD
Fosså
Department of Pediatric Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Ellen
E
Ruud
National Advisory Unit for Late Effects After Cancer Treatment, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.
Cecilie E
CE
Kiserud
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Svend
S
Aakhus
D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D066126:Cardiotoxicity / Q000000981:diagnostic imaging* / Q000209:etiology; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000628:therapy*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D013318:Stroke Volume; D017741:Survivors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D055815:Young Adult
D018943:Anthracyclines; D000970:Antineoplastic Agents