Longitudinal evaluation of anthracycline-induced cardiac dysfunction in childhood cancer survivors

Panjer, J.A. (2016) Longitudinal evaluation of anthracycline-induced cardiac dysfunction in childhood cancer survivors. thesis, Medicine.

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Abstract

Introduction Cardiac late effects are common among childhood cancer survivors (CCS). Until now most studies on these late effects are cross-sectional studies. The purpose of this longitudinal follow-up study with a median follow-up time of 21.8 years was to gain more information on the course of anthracycline-induced cardiac late effects. Methods The population we studied consisted of 137 CCS (median age 32.5 (21.8-56.6)) treated with potentially cardiotoxic treatment. These CCS were participants in a previous study (2004-2008) in the University Medical Center Groningen (UMCG) on cardiac late effects, for which an echocardiogram was made (now referred to as ‘first echocardiogram’). To screen for cardiac late effects echocardiograms are made of these CCS once or twice every five years as standard follow-up care. We collected the echocardiograms that were made after the first echocardiogram and compared the most recent echocardiogram to the first one (median of 6.5 years between the two echocardiograms). Outcome variables were shortening fraction (SF) and left ventricle ejection fraction (LVEF) for the systolic function and E’septal and E’lateral for the diastolic function. Results After median 6.5 years (3.2-10.0) follow-up no difference was found with respect to systolic function (SF (p=0.180) and LVEF (p=0.423)). The diastolic function (E’septal and E’lateral) however worsened significantly (p<0.001). Asymptomatic diastolic dysfunction was present in 51.9% of all CCS at the last echocardiogram. CCS with asymptomatic diastolic dysfunction at the first echocardiogram were significantly older compared to CCS without diastolic dysfunction at the first echocardiogram (p<0.001). They did not have a worse systolic function (SF, p=0.779)or E’septal (p=0.372) at the last echocardiogram compared to CCS without previous diastolic dysfunction. E’lateral worsened more (p=0.007) in CCS without previous diastolic dysfunction than in CCS with previous diastolic dysfunction. Conclusion CCS are at a high risk of developing (asymptomatic) diastolic dysfunction. At first sight, CCS with asymptomatic diastolic dysfunction do not seem to worsen faster compared to other CCS. The clinical relevance and course of asymptomatic diastolic dysfunction remain uncertain. Further research is needed to clarify this.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Tissing, dr. W.J.E. and Institution: Cancer Research Center Groningen Department: Pa
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:03
Last Modified:	25 Jun 2020 11:03
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2280

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