Cardiac Function After Cardiotoxic Treatments for Childhood Cancer—Left Ventricular Longitudinal Strain in Screening

Niemelä, Jussi; Ylänen, Kaisa; Suominen, Anu; Pushparajah, Kuberan; Mathur, Sujeev; Sarkola, Taisto; Jahnukainen, Kirsi; Eerola, Anneli; Poutanen, Tuija; Vettenranta, Kim; Ojala, Tiina

doi:10.3389/fcvm.2021.715953

Cited by 11 publications

(26 citation statements)

References 38 publications

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“…Including analysis of LS has therefore T A B L E 2 Re-analysis of FS and LVEF in echocardiograms eligible for LS-analysis. been suggested as an option when GLS is not feasible, 27,28 since LSanalysis only requires a standard apical four-chamber view of the left ventricle of adequate image quality and frame rate. 41,42 The feasibility, as well as the reproducibility, sensitivity and specificity, of an echocardiographic method are of relevance both in research and in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…LS, and preferably GLS, may be particularly useful to further scrutinize the significance of borderline FS or LVEF values and aid in decision-making regarding surveillance intensity, both during and after anthracycline treatment. 10,27,28,41 To improve the understanding of the variable course of individual patients and to provide outcome measures for further research on early detection of cardiovascular toxicity, adherence to detailed standardized echocardiographic protocols including left ventricular systolic strain analysis 46 (preferably GLS, alternatively LS) should be implemented in clinical practice. We are now preparing a prospective study to validate LS and GLS in echocardiographic surveillance during and after anthracycline treatment in children to confirm and expand the retrospective results presented here.…”

Section: Discussionmentioning

confidence: 99%

“…Impairment in GLS of >15% from baseline or deformation measured by GLS less than 17% is defined as significant deterioration 9,23,26 . Previous studies indicate that deterioration in GLS, as well as in LS, during and early after anthracycline treatment may identify individuals at higher risk of subsequent cardiac dysfunction 14,27,28 . In children, the prognostic importance of GLS and LS warrants further clarification and these methods are not included in standard pediatric cancer surveillance protocols 8,29 .…”

Section: Introductionmentioning

confidence: 99%

“…27,28 Median values for vLVEF and FS remained above the cut-off values for defining ventricular dys-…”

mentioning

confidence: 98%

“…366 echocardiograms, which might pose a problem in clinical decision-making. In these cases, GLS or LS measurements may facilitate the evaluation of left ventricular systolic performance.Besides the size of the patient cohort and sort follow-up time, a weakness of this study, shared by other retrospective studies on echocardiograms performed in clinical practice, was the limitation of acquired images 28. I G U R E 2 (Continued) F I G U R E 3 (A) and (B) Longitudinal follow-ups of median values and interquartile range of visual LVEF and FS in patients with normal LS (≥17%) at all times (red) or abnormal LS (<17%) (green) at any time, according to cumulative doxorubicin equivalent dose-intervals (mg/m 2 ) during treatment and time after last anthracycline dose during follow-up.…”

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confidence: 99%

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Longitudinal strain analysis for assessment of early cardiotoxicity during anthracycline treatment in childhood sarcoma: A single center experience

Alpman,

Jarting,

Magnusson

et al. 2023

Cancer Reports

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BackgroundThe growing population of long‐term childhood cancer survivors encounter a substantial burden of cardiovascular complications. The highest risk of cardiovascular complications is associated with exposure to anthracyclines and chest radiation. Longitudinal cardiovascular surveillance is recommended for childhood cancer patients; however, the optimal methods and timing are yet to be elucidated.AimsWe aimed to investigate the feasibility of different echocardiographic methods to evaluate left ventricular systolic function in retrospective datasets, including left ventricular ejection fraction (LVEF), fractional shortening (FS), global longitudinal strain (GLS) and longitudinal strain (LS) as well as the incidence and timing of subclinical left ventricular dysfunction detected by these methods.Methods and ResultsA retrospective longitudinal study was performed with re‐analysis of longitudinal echocardiographic data, acquired during treatment and early follow‐up, including 41 pediatric sarcoma patients, aged 2.1–17.8 years at diagnosis, treated at Astrid Lindgren Children's Hospital, Stockholm, Sweden, during the period 2010–2021. All patients had received treatment according to protocols including high cumulative doxorubicin equivalent doses (≥250 mg/m2). In 68% of all 366 echocardiograms, LS analysis was feasible. Impaired LS values (<17%) was demonstrated in >40%, with concomitant impairment of either LVEF or FS in 20% and combined impairment of both LVEF and FS in <10%. Importantly, there were no cases of abnormal LVEF and FS without concomitant LS impairment.ConclusionOur findings demonstrate feasibility of LS in a majority of echocardiograms and a high incidence of impaired LS during anthracycline treatment for childhood sarcoma. We propose inclusion of LS in pediatric echocardiographic surveillance protocols.

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