Echocardiographic myocardial strain analysis describes subclinical cardiac dysfunction after craniospinal irradiation in pediatric and young adult patients with central nervous system tumors

Abstract

Background Craniospinal irradiation (CSI) is part of the treatment of central nervous system (CNS) tumors and is associated with cardiovascular disease in adults. Global myocardial strain analysis including longitudinal peak systolic strain (GLS), circumferential peak systolic strain (GCS), and radial peak systolic strain (GRS) can reveal subclinical cardiac dysfunction. Methods Retrospective, single-center study in patients managed with CSI vs. age-matched controls. Clinical data and echocardiography, including myocardial strain analysis, were collected at early (< 12 months) and late (≥ 12 months) time points after completion of CSI. Results Echocardiograms were available at 20 early and 34 late time points. Patients at the late time point were older (21.7 ± 10.4 vs. 13.3 ± 9.6 years) and further out from CSI (13.1 ± 8.8 vs. 0.2 ± 0.3 years). Standard echocardiographic parameters were normal for both groups. For early, CSI vs. control: GLS was − 16.8 ± 3.6% vs. -21.3 ± 4.0% (p = 0.0002), GCS was − 22.5 ± 5.2% vs. -21.3 ± 3.4% (p = 0.28), and GRS was 21.8 ± 11.0% vs. 26.9 ± 7.7% (p = 0.07). For late, CSI vs. control: GLS was − 16.2 ± 5.4% vs. -21.6 ± 3.7% (p < 0.0001), GCS was − 20.9 ± 6.8% vs. -21.9 ± 3.5% (p = 0.42), and GRS was 22.5 ± 10.0% vs. 27.3 ± 8.3% (p = 0.03). Radiation type (proton vs. photon), and radiation dose (< 30 Gy vs. ≥ 30 Gy) did not impact any parameter, although numbers were small. Conclusions Subclinical cardiac systolic dysfunction by GLS is present both early and late after CSI. These results argue for future studies to determine baseline cardiovascular status and the need for early initiation of longitudinal follow-up post CSI.

Utility of apical four‐chamber longitudinal strain in the assessment of childhood cancer survivors: A multicenter study

“…Changes in GLS have been shown be an early indicator of cardiac dysfunction in CCS. [12][13][14][15][16] However, retrospective analysis of GLS as a predictive measure of heart failure development is limited by only having single plane apical 4-chamber views recorded in many older archived studies. This was the most common reason GLS as measured from three apical planes with 2D speckle tracking could not be determined in a previous GLS analysis.…”

Cardiac dysfunction in medulloblastoma survivors treated with photon irradiation

“…Myocardial strain is a noninvasive measurement on 2-dimentional speckle tracing ECHO, it is reported as a percent that can be measured by global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS). Prior studies have demonstrated decreased GLS and GSC despite normal left ventricular EF or SF in childhood cancer survivors, implying presence of LV systolic dysfunction or subclinical myocardial dysfunction [35][36][37][38][39]. Reduction in GLS by 10 to 15% appears to be the most useful parameter for prediction of cardiotoxicity, as it may de ne a decrease in LVEF or heart failure.…”

“…The true value in predicting subsequent ventricular dysfunction or heart failure needs to be further evaluated. In a recent article by Martinez et al, the ECHO results from 51 patients treated for pediatric CNS malignancies at Cincinnati Children's Hospital with CSI who had at least one ECHO done after CSI, did not have abnormal left ventricular dysfunction noted [39]. However, abnormal cardiac strain was demonstrated [39].…”

Pediatric Cardio-Oncology Medicine: A New Approach in Cardiovascular Care

“…Left ventricular systolic dysfunction has been extensively investigated and has been linked to suboptimal outcomes while undergoing cancer management [ 21 , 47 ]. In children, EF% and strain analysis remain the surrogate markers to evaluate ventricular dysfunction [ 3 , 14 , 48 , 49 ]. Global longitudinal strain has been reported to be the most efficient strain parameter to quantify left ventricular mechanics.…”

“…Global longitudinal strain has been reported to be the most efficient strain parameter to quantify left ventricular mechanics. In our experience, it has been helpful to identify focal and global ventricular dysfunction although we recommend reviewing vendor-specific values of normal/abnormal when using it clinically [ 14 , 48 , 50 ]. When the ventricular systolic function is suboptimal at the regional or global levels, the use of beta-blockers (BB), angiotensin-converting-enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs) has been associated with cardio protection [ 3 , 21 , 51 , 52 ].…”