Speckle tracking echocardiography detects decreased cardiac longitudinal function in anthracycline-exposed survivors of childhood cancer.
Longitudinal motion significantly contributes to the contraction of the ventricles. We studied the left (LV) and right ventricular (RV) longitudinal functions in 75 anthracycline-exposed, long-term childhood cancer survivors and 75 healthy controls with conventional echocardiography, tissue Doppler imaging (TDI), speckle tracking echocardiography (STE) of the mitral and tricuspid annular motion, and real-time three-dimensional echocardiography (RT-3DE). Cardiac magnetic resonance (CMR) imaging was performed on 61 of the survivors. The survivors had lower systolic myocardial velocities in the LV and lower diastolic velocities in both ventricles by TDI than did their healthy peers. The STE-based tissue motion annular displacement (TMAD) values describing the LV and RV systolic longitudinal function (MAD and TAD mid%, respectively) were also lower among the survivors (15.4 ± 2.4 vs. 16.1 ± 2.2 %, p = 0.049 and 22.5 ± 3.0 vs. 23.5 ± 3.0 %, p = 0.035). MAD and TAD mid in millimeters correlated with the respective ventricular volumes measured with RT-3DE or CMR.


CONCLUSIONS
Childhood cancer survivors exposed to low to moderate anthracycline doses had decreased longitudinal systolic and diastolic functions (TDI or STE) compared with healthy controls. The STE-based TMAD is a fast and reproducible method to assess cardiac longitudinal function. What is Known? • High anthracycline doses cause LV dysfunction as evidenced by a decreased ejection fraction. What is new? • Low to moderate anthracycline doses also have a negative impact on the LV and RV longitudinal systolic and diastolic function. • TMAD is a new and fast method to assess the cardiac longitudinal function after anthracycline exposure.
Department of Pediatrics, Tampere University Hospital, PO BOX 2000, FIN-33521, Tampere, Finland. kaisa@ylanen.fi.|University of Tampere, Tampere, Finland. kaisa@ylanen.fi.
Kaisa
http://orcid.org/0000-0002-2189-1020
K
Ylänen
Department of Pediatrics, Tampere University Hospital, PO BOX 2000, FIN-33521, Tampere, Finland.
Anneli
A
Eerola
Hospital for Children and Adolescents, PO BOX 281, FIN-00029 HUS, Helsinki, Finland.|University of Helsinki, Helsinki, Finland.
Kim
K
Vettenranta
Department of Pediatrics, Tampere University Hospital, PO BOX 2000, FIN-33521, Tampere, Finland.|University of Tampere, Tampere, Finland.
Tuija
T
Poutanen
D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D017741:Survivors; D013599:Systole / Q000187:drug effects / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging; D018497:Ventricular Dysfunction, Right / Q000139:chemically induced* / Q000000981:diagnostic imaging
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic
Anthracycline; Child; Malignancy; Speckle tracking; Tissue Doppler imaging