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Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy

BACKGROUND: Cardiovascular disease (CVD) is the leading non-malignant cause of death in childhood cancer survivors. Heightened risk of CVD is often attributable to treatment with anthracycline chemotherapy. Anthracycline-mediated cardiac injury may lie latent for years following cessation of treatme...

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Autores principales: Long, Treya M., Marsh, Channa E., Dembo, Lawrence G., Watson, Philip, Wallman, Karen E., Walwyn, Thomas S., Choong, Catherine S., Naylor, Louise H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048057/
https://www.ncbi.nlm.nih.gov/pubmed/32154017
http://dx.doi.org/10.1186/s40959-019-0047-4
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author Long, Treya M.
Marsh, Channa E.
Dembo, Lawrence G.
Watson, Philip
Wallman, Karen E.
Walwyn, Thomas S.
Choong, Catherine S.
Naylor, Louise H.
author_facet Long, Treya M.
Marsh, Channa E.
Dembo, Lawrence G.
Watson, Philip
Wallman, Karen E.
Walwyn, Thomas S.
Choong, Catherine S.
Naylor, Louise H.
author_sort Long, Treya M.
collection PubMed
description BACKGROUND: Cardiovascular disease (CVD) is the leading non-malignant cause of death in childhood cancer survivors. Heightened risk of CVD is often attributable to treatment with anthracycline chemotherapy. Anthracycline-mediated cardiac injury may lie latent for years following cessation of treatment and is therefore often not detected until disease is advanced and aggressive therapy is required. Symptomatic CVD may be preceded by subclinical cardiac and vascular dysfunction. This study aimed to determine whether such dysfunction could be detected in healthy, anthracycline-treated survivors of childhood leukaemia. METHODS: Cardiac magnetic resonance imaging (cMRI) with late gadolinium enhancement and endothelial function were used to characterise pre-clinical stages of CVD. Twenty-two long-term (>5 years survival; age 21 ± 3 years) childhood leukaemia survivors were assessed. All survivors were asymptomatic and had normal resting echocardiography. To exclude potential confounding effects of radiotherapy, no survivors had received this treatment. Twenty-two similarly aged (25 ± 3 years) gender-matched controls were recruited for comparison. RESULTS: Left ventricular ejection fraction was lower in the survivors (55.0 ± 4.6%) compared to the controls (59.4 ± 6.2%; p = 0.010). Further, five survivors (23%) had clinically reduced (<50%) left ventricular ejection fraction. Normalised left ventricular end systolic volume was augmented in survivors (40.0 ± 9.1 mL·m(2) vs. 34.5 ± 7.5 mL·m(2); p = 0.038). Cardiac MRI did not show any late gadolinium enhancement. High resolution, ultrasound-derived flow mediated dilation was impaired in survivors (6.7 ± 2.1% vs. 8.60 ± 1.91%, p = 0.005). CONCLUSIONS: We detected subclinical changes in cardiovascular structure and function indicative of early disease in anthracycline-treated childhood leukaemia survivors with normal echocardiography. Early detection and characterisation of underlying disease allows for timely intervention and improved outcomes in this at-risk population.
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spelling pubmed-70480572020-03-09 Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy Long, Treya M. Marsh, Channa E. Dembo, Lawrence G. Watson, Philip Wallman, Karen E. Walwyn, Thomas S. Choong, Catherine S. Naylor, Louise H. Cardiooncology Research BACKGROUND: Cardiovascular disease (CVD) is the leading non-malignant cause of death in childhood cancer survivors. Heightened risk of CVD is often attributable to treatment with anthracycline chemotherapy. Anthracycline-mediated cardiac injury may lie latent for years following cessation of treatment and is therefore often not detected until disease is advanced and aggressive therapy is required. Symptomatic CVD may be preceded by subclinical cardiac and vascular dysfunction. This study aimed to determine whether such dysfunction could be detected in healthy, anthracycline-treated survivors of childhood leukaemia. METHODS: Cardiac magnetic resonance imaging (cMRI) with late gadolinium enhancement and endothelial function were used to characterise pre-clinical stages of CVD. Twenty-two long-term (>5 years survival; age 21 ± 3 years) childhood leukaemia survivors were assessed. All survivors were asymptomatic and had normal resting echocardiography. To exclude potential confounding effects of radiotherapy, no survivors had received this treatment. Twenty-two similarly aged (25 ± 3 years) gender-matched controls were recruited for comparison. RESULTS: Left ventricular ejection fraction was lower in the survivors (55.0 ± 4.6%) compared to the controls (59.4 ± 6.2%; p = 0.010). Further, five survivors (23%) had clinically reduced (<50%) left ventricular ejection fraction. Normalised left ventricular end systolic volume was augmented in survivors (40.0 ± 9.1 mL·m(2) vs. 34.5 ± 7.5 mL·m(2); p = 0.038). Cardiac MRI did not show any late gadolinium enhancement. High resolution, ultrasound-derived flow mediated dilation was impaired in survivors (6.7 ± 2.1% vs. 8.60 ± 1.91%, p = 0.005). CONCLUSIONS: We detected subclinical changes in cardiovascular structure and function indicative of early disease in anthracycline-treated childhood leukaemia survivors with normal echocardiography. Early detection and characterisation of underlying disease allows for timely intervention and improved outcomes in this at-risk population. BioMed Central 2019-08-14 /pmc/articles/PMC7048057/ /pubmed/32154017 http://dx.doi.org/10.1186/s40959-019-0047-4 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Long, Treya M.
Marsh, Channa E.
Dembo, Lawrence G.
Watson, Philip
Wallman, Karen E.
Walwyn, Thomas S.
Choong, Catherine S.
Naylor, Louise H.
Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy
title Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy
title_full Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy
title_fullStr Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy
title_full_unstemmed Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy
title_short Early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy
title_sort early markers of cardiovascular injury in childhood leukaemia survivors treated with anthracycline chemotherapy
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048057/
https://www.ncbi.nlm.nih.gov/pubmed/32154017
http://dx.doi.org/10.1186/s40959-019-0047-4
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