Author + information
- Niti Dham,
- Deepa Mokshagundam,
- Laura Olivieri,
- Robert McCarter,
- Aerang Kim,
- Craig Sable and
- Christopher Spurney
Cardiac damage from chemotherapy is a known phenomenon. Identifying high risk pediatric patients early is challenging, leading to significant morbidity and mortality in the cancer surviving population. We aimed to identify these patients by correlating known and new risk factors (oncologic, serum, echocardiographic, and cardiac MRI) in pediatric cancer survivors that could be followed long term, aid management, and potentially change future guidelines.
In our pilot study, we prospectively enrolled pediatric subjects after completion of anthracycline inclusive chemotherapy. Each subject underwent a post-treatment echocardiogram (standard with strain), serum biomarkers (N-terminal brain natriuretic peptide (BNP) and Soluble 2 (ST2)), and a cardiac MRI (standard and Extracellular Volumes (ECV)). We correlated the markers using Pearson correlation.
We enrolled 30 subjects, 11F/19M, aged 8-21 years. Cumulative anthracycline dose (CAD) correlated with BNP (R = 0.36, p = 0.06), MRI ECV (4 chamber (R = 0.4, p = 0.05) and sagittal (R = 0.48, p = 0.01)), and mitral valve e/a (R = −0.45, p = 0.02). Time from completion of treatment correlated with BNP, echo LV size, and echo circumferential strain. BNP correlated with MRI ECV (4 chamber (R = 0.61, p = 0.001) and sagittal (R = 0.61, p = 0.001)) and had a trend with echo 4 chamber strain (R = 0.14, 0.05). ST2 had a trend with MRI ECV (4 chamber (R = 0.27, p = 0.008) and sagittal (R = 0.25, p = 0.008)) and a correlation with echo 4 chamber strain (R = 0.4, p = 0.03). Wall stress correlated with ejection fraction, shortening fraction, echo LV size, echo 4 chamber strain, and MRI ECV. Echo 4 chamber strain also correlated with echo LV size, ejection fraction, and shortening fraction.
The correlation of CAD with BNP and MRI ECV and serum biomarkers with MRI ECV and 4 chamber strain is enlightening. Combining these parameters with known echo derived precursors has the potential to identify high-risk patients early. Further studies are needed for long term follow up and management in this vulnerable population.
Poster Hall, Hall F
Sunday, March 17, 2019, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure and Cardiomyopathies: Clinical 3
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1244-560
- 2019 American College of Cardiology Foundation