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Chemotherapy-related cardiotoxicity (CTRC) is associated with significant morbidity and mortality in long-term cancer survivors. Left ventricular [LV] Global longitudinal strain (GLS) is a sensitive parameter that can be used for earlier detection of contractile function changes in these patients. Recent literature suggested certain genotypes may influence CTRC. Our goal was to assess longitudinal myocardial function and identify any correlation between certain genetic variations and LV function regarding CTRC in our pediatric population.


50 subjects ≥10 years of age who have survived >2 years after completion of cancer treatment were enrolled out of which 29 subjects agreed for genetic analysis and follow-up evaluation of echocardiograms. Echocardiographic data from these 29 subjects was reviewed. Apical 4 chamber and short axis at the level of papillary muscles were used for area-length 2D Ejection fraction (EF) [bullet method], and apical 4 chamber image was used for GLS. GLS was performed by using speckle tracing retrospectively with 2D STE offline analysis software (4D LV-Analysis 3) developed by TomTec Imaging Systems. Seventeen of these 29 patients had longitudinal echocardiographic data available for serial measurement of their EF and GLS. GLS ≤-18% was considered normal. Paired t-test analysis was performed for these patients with follow-up data available using SPSS statistics 27.0. All 29 patients underwent whole exome sequencing for genetic polymorphism, the results of which are pending at the time of submitting this abstract.


Baseline GLS was normal in 28/29 patients (96.5%). Mean GLS was -21.71% ± 2.36 %. Mean EF was 60.1% ± 5.4%. Mean follow-up duration was 4.1 years [range 2.2-6.5 years]. At follow-up evaluation, the mean reduction of strain was 1.4 % [standard deviation (SD) of 2.1, p = 0.015] and reduction of EF was 1% [SD of 5.6, p=0.45]. Longitudinal data in 17 patients showed a decrease in GLS by >2% in 47 % of patients, however, only 11.7% of the patients had a concomitant significant decrease in EF of ≥5%.


In this cohort of pediatric cancer patients, clinically all were asymptomatic; in New York Heart Association Heart failure class 1. With a mean follow-up period of 4 years, there was statistically significant reduction in GLS while EF essentially remained stable. GLS can be a more sensitive marker to assess longitudinal ventricular function than EF and can be a valuable tool in risk-stratifying patient receiving cardiotoxic chemotherapy. Additional multi-center longitudinal studies evaluating the long-term prognostic implications of reduced LV GLS in this population are essential.


Cardiology | Oncology


Presented at the American Society of Echocardiography 2021 Conference June 18, 21, 2021.

Longitudinal analysis of myocardial function using strain in patients receiving cardiotoxic chemotherapy