Longitudinal Changes in Echocardiographic Parameters of Cardiac Function in Pediatric Cancer Survivors

William L Border, Ritu Sachdeva, Kayla L Stratton, Saro H Armenian, Aarti Bhat, David E Cox, Kasey J Leger, Wendy M Leisenring, Lillian R Meacham, Karim T Sadak, Shanthi Sivanandam, Paul C Nathan, Eric J Chow

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives: The purpose of this study was to assess the timing of changes in serial echocardiographic parameters in pediatric cancer survivors and to evaluate their associations with cardiomyopathy development. Background: Pediatric cancer survivors undergo serial echocardiograms to screen for cardiotoxicity. It is not clear whether small longitudinal changes in functional or structural parameters over time have clinical significance. Methods: This is a multicenter, retrospective, case-control study of ≥1-year survivors following the end of cancer therapy. Cardiomyopathy cases (fractional shortening [FS] ≤28% or ejection fraction [EF] ≤50% on ≥2 occasions) were matched to control subjects (FS ≥30%, EF ≥55%, not on cardiac medications) by cumulative anthracycline and chest radiation dose, follow-up duration, and age at diagnosis. Digitally archived clinical surveillance echocardiograms were quantified in a central core laboratory, blinded to patient characteristics. Using mixed models with interaction terms between time and case status, we estimated the least square mean differences of 2-dimensional, M-mode, pulsed wave Doppler, and tissue Doppler imaging–derived parameters over time between cases and control subjects. Results: We identified 50 matched case-control pairs from 5 centers. Analysis of 412 echocardiograms (cases, n = 181; control subjects, n = 231) determined that indices of left ventricular systolic function (FS, biplane EF), diastolic function (mitral E/A ratio), and left ventricular size (end-diastolic dimension z-scores) were significantly different between cases and control subjects, even 4 years prior to the development of cardiomyopathy. Conclusions: Longitudinal changes in cardiac functional parameters can occur relatively early in pediatric cancer survivors and are associated with the development of cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)26-37
Number of pages12
JournalJACC. CardioOncology
Issue number1
StatePublished - Mar 2020

Bibliographical note

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© 2020 The Authors

Copyright 2021 Elsevier B.V., All rights reserved.


  • cancer survivorship
  • cardiomyopathy
  • echocardiography
  • longitudinal

PubMed: MeSH publication types

  • Journal Article


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