Evaluation of traditional and novel measures of cardiac function to detect anthracycline-induced cardiotoxicity in survivors of childhood cancer

Andrew C. Dietz, Shanthi Sivanandam, Suma Konety, Christopher L. Kaufman, Ryan M. Gage, Aaron S. Kelly, Joseph P. Neglia, Daniel A. Mulrooney

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: Cardiovascular disease is the leading noncancer cause of death among survivors of childhood cancer. Ejection fraction (EF) and fractional shortening (FS) are common echocardiographic measures of cardiac function, but newer imaging modalities may provide additional information about preclinical disease. This study aimed to evaluate these modalities in detection of anthracycline-induced cardiac toxicity. Methods: We compared mean radial displacement, EF, and FS among 17 adult survivors of childhood cancer exposed to ≥ 300 mg/m2 of anthracyclines to 17 age- and sex-matched healthy controls. Survivors with a history of cardiac-directed radiation, diabetes, or heart disease were excluded. Results: Survivors (35 % male), mostly with history of treatment for a solid tumor, had a median age at diagnosis of 15 years (1-20) and 27 years (18-50) at evaluation. Median anthracycline exposure was 440 (range 300-645) mg/m2. FS (35.5 vs. 39.6 %, p < 0.01) and radial displacement (5.6 vs. 6.7 mm, p = 0.02) were significantly lower in survivors compared to controls, respectively. Although the mean EF was lower in survivors versus controls (55.4 vs. 59.7 %), it was not statistically significant (p = 0.057). All echocardiographic measures were inversely associated with anthracycline dose, though radial displacement was no longer significantly correlated with anthracycline dose after controlling for survival time (p = 0.07), while EF remained correlated (p = 0.003). Implications for Cancer Survivors: Radial displacement, EF, and FS are lower in childhood cancer survivors compared to controls. In this study, radial displacement added no new information beyond the traditional measures, but clinical utility remains undetermined and requires further longitudinal study.

Original languageEnglish (US)
Pages (from-to)183-189
Number of pages7
JournalJournal of Cancer Survivorship
Volume8
Issue number2
DOIs
StatePublished - Jun 2014

Fingerprint

Anthracyclines
Survivors
Neoplasms
Cardiotoxicity
Longitudinal Studies
Cause of Death
Heart Diseases
Cardiovascular Diseases
Radiation
Survival

Keywords

  • Cancer survivorship
  • Cardiotoxicity
  • Echocardiography

Cite this

Evaluation of traditional and novel measures of cardiac function to detect anthracycline-induced cardiotoxicity in survivors of childhood cancer. / Dietz, Andrew C.; Sivanandam, Shanthi; Konety, Suma; Kaufman, Christopher L.; Gage, Ryan M.; Kelly, Aaron S.; Neglia, Joseph P.; Mulrooney, Daniel A.

In: Journal of Cancer Survivorship, Vol. 8, No. 2, 06.2014, p. 183-189.

Research output: Contribution to journalArticle

@article{ce57d4d956a043d38f9ee9e79da47171,
title = "Evaluation of traditional and novel measures of cardiac function to detect anthracycline-induced cardiotoxicity in survivors of childhood cancer",
abstract = "Purpose: Cardiovascular disease is the leading noncancer cause of death among survivors of childhood cancer. Ejection fraction (EF) and fractional shortening (FS) are common echocardiographic measures of cardiac function, but newer imaging modalities may provide additional information about preclinical disease. This study aimed to evaluate these modalities in detection of anthracycline-induced cardiac toxicity. Methods: We compared mean radial displacement, EF, and FS among 17 adult survivors of childhood cancer exposed to ≥ 300 mg/m2 of anthracyclines to 17 age- and sex-matched healthy controls. Survivors with a history of cardiac-directed radiation, diabetes, or heart disease were excluded. Results: Survivors (35 {\%} male), mostly with history of treatment for a solid tumor, had a median age at diagnosis of 15 years (1-20) and 27 years (18-50) at evaluation. Median anthracycline exposure was 440 (range 300-645) mg/m2. FS (35.5 vs. 39.6 {\%}, p < 0.01) and radial displacement (5.6 vs. 6.7 mm, p = 0.02) were significantly lower in survivors compared to controls, respectively. Although the mean EF was lower in survivors versus controls (55.4 vs. 59.7 {\%}), it was not statistically significant (p = 0.057). All echocardiographic measures were inversely associated with anthracycline dose, though radial displacement was no longer significantly correlated with anthracycline dose after controlling for survival time (p = 0.07), while EF remained correlated (p = 0.003). Implications for Cancer Survivors: Radial displacement, EF, and FS are lower in childhood cancer survivors compared to controls. In this study, radial displacement added no new information beyond the traditional measures, but clinical utility remains undetermined and requires further longitudinal study.",
keywords = "Cancer survivorship, Cardiotoxicity, Echocardiography",
author = "Dietz, {Andrew C.} and Shanthi Sivanandam and Suma Konety and Kaufman, {Christopher L.} and Gage, {Ryan M.} and Kelly, {Aaron S.} and Neglia, {Joseph P.} and Mulrooney, {Daniel A.}",
year = "2014",
month = "6",
doi = "10.1007/s11764-013-0326-2",
language = "English (US)",
volume = "8",
pages = "183--189",
journal = "Journal of Cancer Survivorship",
issn = "1932-2259",
publisher = "Springer New York",
number = "2",

}

TY - JOUR

T1 - Evaluation of traditional and novel measures of cardiac function to detect anthracycline-induced cardiotoxicity in survivors of childhood cancer

AU - Dietz, Andrew C.

AU - Sivanandam, Shanthi

AU - Konety, Suma

AU - Kaufman, Christopher L.

AU - Gage, Ryan M.

AU - Kelly, Aaron S.

AU - Neglia, Joseph P.

AU - Mulrooney, Daniel A.

PY - 2014/6

Y1 - 2014/6

N2 - Purpose: Cardiovascular disease is the leading noncancer cause of death among survivors of childhood cancer. Ejection fraction (EF) and fractional shortening (FS) are common echocardiographic measures of cardiac function, but newer imaging modalities may provide additional information about preclinical disease. This study aimed to evaluate these modalities in detection of anthracycline-induced cardiac toxicity. Methods: We compared mean radial displacement, EF, and FS among 17 adult survivors of childhood cancer exposed to ≥ 300 mg/m2 of anthracyclines to 17 age- and sex-matched healthy controls. Survivors with a history of cardiac-directed radiation, diabetes, or heart disease were excluded. Results: Survivors (35 % male), mostly with history of treatment for a solid tumor, had a median age at diagnosis of 15 years (1-20) and 27 years (18-50) at evaluation. Median anthracycline exposure was 440 (range 300-645) mg/m2. FS (35.5 vs. 39.6 %, p < 0.01) and radial displacement (5.6 vs. 6.7 mm, p = 0.02) were significantly lower in survivors compared to controls, respectively. Although the mean EF was lower in survivors versus controls (55.4 vs. 59.7 %), it was not statistically significant (p = 0.057). All echocardiographic measures were inversely associated with anthracycline dose, though radial displacement was no longer significantly correlated with anthracycline dose after controlling for survival time (p = 0.07), while EF remained correlated (p = 0.003). Implications for Cancer Survivors: Radial displacement, EF, and FS are lower in childhood cancer survivors compared to controls. In this study, radial displacement added no new information beyond the traditional measures, but clinical utility remains undetermined and requires further longitudinal study.

AB - Purpose: Cardiovascular disease is the leading noncancer cause of death among survivors of childhood cancer. Ejection fraction (EF) and fractional shortening (FS) are common echocardiographic measures of cardiac function, but newer imaging modalities may provide additional information about preclinical disease. This study aimed to evaluate these modalities in detection of anthracycline-induced cardiac toxicity. Methods: We compared mean radial displacement, EF, and FS among 17 adult survivors of childhood cancer exposed to ≥ 300 mg/m2 of anthracyclines to 17 age- and sex-matched healthy controls. Survivors with a history of cardiac-directed radiation, diabetes, or heart disease were excluded. Results: Survivors (35 % male), mostly with history of treatment for a solid tumor, had a median age at diagnosis of 15 years (1-20) and 27 years (18-50) at evaluation. Median anthracycline exposure was 440 (range 300-645) mg/m2. FS (35.5 vs. 39.6 %, p < 0.01) and radial displacement (5.6 vs. 6.7 mm, p = 0.02) were significantly lower in survivors compared to controls, respectively. Although the mean EF was lower in survivors versus controls (55.4 vs. 59.7 %), it was not statistically significant (p = 0.057). All echocardiographic measures were inversely associated with anthracycline dose, though radial displacement was no longer significantly correlated with anthracycline dose after controlling for survival time (p = 0.07), while EF remained correlated (p = 0.003). Implications for Cancer Survivors: Radial displacement, EF, and FS are lower in childhood cancer survivors compared to controls. In this study, radial displacement added no new information beyond the traditional measures, but clinical utility remains undetermined and requires further longitudinal study.

KW - Cancer survivorship

KW - Cardiotoxicity

KW - Echocardiography

UR - http://www.scopus.com/inward/record.url?scp=84900336239&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84900336239&partnerID=8YFLogxK

U2 - 10.1007/s11764-013-0326-2

DO - 10.1007/s11764-013-0326-2

M3 - Article

C2 - 24317971

AN - SCOPUS:84900336239

VL - 8

SP - 183

EP - 189

JO - Journal of Cancer Survivorship

JF - Journal of Cancer Survivorship

SN - 1932-2259

IS - 2

ER -