Longitudinal Changes in Echocardiographic Parameters of Cardiac Function in Pediatric Cancer Survivors

William L. Border, Ritu Sachdeva, Kayla L. Stratton, Saro H. Armenian, Aarti Bhat, David E. Cox, Kasey J. Leger, Wendy M. Leisenring, Lillian R. Meacham, Karim T. Sadak, Shanthi Sivanandam, Paul C. Nathan, Eric J. Chow

Research output: Contribution to journalArticlepeer-review


Objectives: The purpose of this study was to assess the timing of changes in serial echocardiographic parameters in pediatric cancer survivors and to evaluate their associations with cardiomyopathy development. Background: Pediatric cancer survivors undergo serial echocardiograms to screen for cardiotoxicity. It is not clear whether small longitudinal changes in functional or structural parameters over time have clinical significance. Methods: This is a multicenter, retrospective, case-control study of ≥1-year survivors following the end of cancer therapy. Cardiomyopathy cases (fractional shortening [FS] ≤28% or ejection fraction [EF] ≤50% on ≥2 occasions) were matched to control subjects (FS ≥30%, EF ≥55%, not on cardiac medications) by cumulative anthracycline and chest radiation dose, follow-up duration, and age at diagnosis. Digitally archived clinical surveillance echocardiograms were quantified in a central core laboratory, blinded to patient characteristics. Using mixed models with interaction terms between time and case status, we estimated the least square mean differences of 2-dimensional, M-mode, pulsed wave Doppler, and tissue Doppler imaging–derived parameters over time between cases and control subjects. Results: We identified 50 matched case-control pairs from 5 centers. Analysis of 412 echocardiograms (cases, n = 181; control subjects, n = 231) determined that indices of left ventricular systolic function (FS, biplane EF), diastolic function (mitral E/A ratio), and left ventricular size (end-diastolic dimension z-scores) were significantly different between cases and control subjects, even 4 years prior to the development of cardiomyopathy. Conclusions: Longitudinal changes in cardiac functional parameters can occur relatively early in pediatric cancer survivors and are associated with the development of cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)26-37
Number of pages12
JournalJACC: CardioOncology
Issue number1
StatePublished - Mar 2020

Bibliographical note

Publisher Copyright:
© 2020 The Authors


  • cancer survivorship
  • cardiomyopathy
  • echocardiography
  • longitudinal

PubMed: MeSH publication types

  • Journal Article

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