Post, S. (Sophie) (2018) Cardiac late effects in patients after childhood cancer treatment within the first five years after diagnosis ---A longitudinal study---. thesis, Medicine.
Full text available on request.Abstract
Introduction In more than half patients after childhood cancer the former treatment leads to various late effects. Cardiotoxicity is one of the most devastating late effects causing long-term morbidity and early mortality. So far longitudinal studies of cardiac late effects are rare and therefore this longitudinal study was performed. The aim was to get more information about the course of cardiac function in patients after childhood cancer within five years after diagnosis. Methods In 125 patients (median age at diagnosis 8.0 (0-17.0) years) clinical and subclinical cardiac late effects were defined. Their cardiac function (systolic and diastolic) was measured by echocardiogram in the University Medical Center Groningen at the moment of diagnosis (T0), one year after (T1) and five year after diagnosis (T2). Occurrence of clinical heart failure was documented. Shortening fraction (SF) and ejection fraction (EF) were used as outcomes to define systolic function and TVImean was used to define diastolic function. Also the impact of the confounders: cumulative dose of anthracyclines, age at diagnosis and gender, possibly affecting the cardiac course, was defined. Additionally, the development of valve pathology was studied. Results No clinical heart failure was documented in our study. However, we found a decline in systolic function (SF, p=0,001) within five years after diagnosis. Moreover, our results showed a decline in systolic function (SF, p=0,004) already within the first year after diagnosis. No change was shown in diastolic function between T0-T1, T0-T2 and between T1-T2. After evaluation of confounders, we found that older age at diagnosis was related to the decline in systolic function within the first year after diagnosis (r2=0,046; p=0,045). Cumulative dose of anthracyclines and gender showed no relation with a decline in systolic function. So far, no development of valve pathology was found in our study. Conclusion Systolic decline was already present within one year after diagnosis, and further decline was observed within five years after diagnosis. This shows that decline in systolic function, as shown in cross-sectional studies, already starts as early as the first year after diagnosis. Secondly, we did not find a decrease in diastolic function whereas it was shown 18 years after diagnosis in previous studies. Therefore we hypothesize that diastolic pathology is different from systolic function. Further follow-up is needed to see whether the of decline systolic function will lead to clinical heart failure and to evaluate the course of diastolic function. This is of importance to find out whether they can predict clinical cardiotoxicity and even cardiac death in future.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Tissing, dr. W.J.E. and Institution: University Medical Center Groningen and Department: Paediatric Oncology |
| 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/2325 |
Actions (login required)
 |
View Item |