A B S T R A C T PurposeTo compare two-dimensional (2D) echocardiography, the current method of screening for treatment-related cardiomyopathy recommended by the Children's Oncology Group Guidelines, to cardiac magnetic resonance (CMR) imaging, the reference standard for left ventricular (LV) function. Patients and MethodsCross-sectional, contemporaneous evaluation of LV structure and function by 2D and threedimensional (3D) echocardiography and CMR imaging in 114 adult survivors of childhood cancer currently median age 39 years (range, 22 to 53 years) exposed to anthracycline chemotherapy and/or chest-directed radiation therapy. ResultsIn this survivor population, 14% (n ϭ 16) had an ejection fraction (EF) less than 50% by CMR. Survivors previously undiagnosed with cardiotoxicity (n ϭ 108) had a high prevalence of EF (32%) and cardiac mass (48%) that were more than two standard deviations below the mean of normative CMR data. 2D echocardiography overestimated the mean EF of this population by 5%. Compared with CMR, 2D echocardiography (biplane method) had a sensitivity of 25% and a false-negative rate of 75% for detection of EF less than 50%, although 3D echocardiography had 53% and 47%, respectively. Twelve survivors (11%) had an EF less than 50% by CMR but were misclassified as Ն 50% (range, 50% to 68%) by 2D echocardiography (biplane method). Detection of cardiomyopathy was improved (sensitivity, 75%) by using a higher 2D echocardiography cutoff (EF Ͻ 60%) to detect an EF less than 50% by the reference standard CMR. ConclusionCMR identified a high prevalence of cardiomyopathy among adult survivors previously undiagnosed with cardiac disease. 2D echocardiography demonstrated limited screening performance. In this high-risk population, survivors with an EF 50% to 59% by 2D echocardiography should be considered for comprehensive cardiac assessment, which may include CMR.

A B S T R A C T PurposeLong-term survivors of childhood Hodgkin lymphoma (HL) are at risk for cardiopulmonary complications and CNS stroke, although neurocognitive function has not been previously examined. The aim of this study was to examine neurocognitive and brain imaging outcomes in adult survivors of childhood HL. Patients and MethodsIn all, 62 adult survivors (mean age, 42.2 years; standard deviation [SD], 4.77; mean age at diagnosis, 15.1 years; SD, 3.30) were identified by stratified random selection from a large cohort treated with either high-dose (Ն 30 Gy) thoracic radiation (n ϭ 38) or lower-dose (Ͻ 30 Gy) thoracic radiation combined with anthracycline (n ϭ 24). Patients underwent neurocognitive evaluations, brain magnetic resonance imaging (MRI), echocardiograms, pulmonary function tests, and physical examinations. ResultsCompared with national age-adjusted norms, HL survivors demonstrated lower performance on sustained attention (P ϭ .004), short-term memory (P ϭ .001), long-term memory (P ϭ .006), working memory (P Ͻ .001), naming speed (P Ͻ .001), and cognitive fluency (P ϭ .007). MRI revealed leukoencephalopathy in 53% of survivors, and 37% had evidence of cerebrovascular injury. Higher thoracic radiation dose was associated with impaired cardiac diastolic function (E/EЈ; ratio of peak mitral flow velocity of early rapid filling [E] to early diastolic velocity of the mitral annulus [EЈ]; P ϭ .003), impaired pulmonary function (diffusing capacity of lungs for carbon monoxide [DL co corr ; P ϭ .04), and leukoencephalopathy (P ϭ .02). Survivors with leukoencephalopathy demonstrated reduced cognitive fluency (P ϭ .001). Working memory impairment was associated with E/EЈ, although impaired sustained attention and naming speed were associated with DL co corr . Neurocognitive performance was associated with academic and vocational functioning. ConclusionThese results suggest that adult long-term survivors of childhood HL are at risk for neurocognitive impairment, which is associated with radiologic indices suggestive of reduced brain integrity and which occurs in the presence of symptoms of cardiopulmonary dysfunction.