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Speckle tracking echocardiography detects decreased cardiac longitudinal function in anthracycline-exposed survivors of childhood cancer

  • Original Article
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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Longitudinal motion significantly contributes to the contraction of the ventricles. We studied the left (LV) and right ventricular (RV) longitudinal functions in 75 anthracycline-exposed, long-term childhood cancer survivors and 75 healthy controls with conventional echocardiography, tissue Doppler imaging (TDI), speckle tracking echocardiography (STE) of the mitral and tricuspid annular motion, and real-time three-dimensional echocardiography (RT-3DE). Cardiac magnetic resonance (CMR) imaging was performed on 61 of the survivors. The survivors had lower systolic myocardial velocities in the LV and lower diastolic velocities in both ventricles by TDI than did their healthy peers. The STE-based tissue motion annular displacement (TMAD) values describing the LV and RV systolic longitudinal function (MAD and TAD mid%, respectively) were also lower among the survivors (15.4 ± 2.4 vs. 16.1 ± 2.2 %, p = 0.049 and 22.5 ± 3.0 vs. 23.5 ± 3.0 %, p = 0.035). MAD and TAD mid in millimeters correlated with the respective ventricular volumes measured with RT-3DE or CMR.

Conclusion: Childhood cancer survivors exposed to low to moderate anthracycline doses had decreased longitudinal systolic and diastolic functions (TDI or STE) compared with healthy controls. The STE-based TMAD is a fast and reproducible method to assess cardiac longitudinal function.

What is Known?

• High anthracycline doses cause LV dysfunction as evidenced by a decreased ejection fraction.

What is new?

• Low to moderate anthracycline doses also have a negative impact on the LV and RV longitudinal systolic and diastolic function.

• TMAD is a new and fast method to assess the cardiac longitudinal function after anthracycline exposure.

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Abbreviations

CMR:

Cardiac magnetic resonance

EDV:

End-diastolic volume

EF:

Ejection fraction

ESV:

End-systolic volume

LV:

Left ventricle/ventricular

MAD:

Mitral annular displacement

RT-3DE:

Real-time three-dimensional echocardiography

RV:

Right ventricle/ventricular

STE:

Speckle tracking echocardiography

TAD:

Tricuspid annular displacement

TAPSE:

Tricuspid annular plane systolic excursion

TDI:

Tissue Doppler imaging

TMAD:

Tissue motion annular displacement

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Acknowledgments

The authors warmly thank Satu Ranta, RN, for the practical assistance during the project.

This work was financially supported by the following sources: the Blood Disease Research Foundation, Helsinki; the Competitive Research Funding of the Tampere University Hospital (9L114 and 9N084), Tampere; the EVO funds of the Tampere University Hospital, Tampere; the Emil Aaltonen Foundation, Tampere; the Finnish Association of Hematology, Helsinki; the Finnish Cancer Foundation, Helsinki; the Finnish Cultural Foundation, Helsinki; the Finnish Cultural Foundation Pirkanmaa Regional Fund, Ylöjärvi; the Finnish Medical Foundation, Helsinki; the Foundation for Pediatric Research, Helsinki; the National Graduate School of Clinical Investigations, Helsinki; the Päivikki and Sakari Sohlberg Foundation, Helsinki; the Scientific Foundation of the City of Tampere, Tampere; and the Väre Foundation for Pediatric Cancer, Helsinki. The funding sources were in no way involved in the design or conduct of the study or writing of the article.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Tampere University Hospital, PO BOX 2000, FIN-33521, Tampere, Finland

    Kaisa Ylänen, Anneli Eerola & Tuija Poutanen

  2. University of Tampere, Tampere, Finland

    Kaisa Ylänen & Tuija Poutanen

  3. Hospital for Children and Adolescents, PO BOX 281, FIN-00029 HUS, Helsinki, Finland

    Kim Vettenranta

  4. University of Helsinki, Helsinki, Finland

    Kim Vettenranta

Authors
  1. Kaisa Ylänen
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  2. Anneli Eerola
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Correspondence to Kaisa Ylänen.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards set by the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants (and/or their legal guardians). No animal data were included.

Conflict of interest

The authors declare that they have no conflicts of interest.

Authors’ contributions

Study concept and design: All authors.

Provision of study materials and patients: Kaisa Ylänen.

Collection and assembly of data: Kaisa Ylänen.

Data analysis and interpretation: All authors.

Manuscript writing: All authors.

Final approval of manuscript: All authors

Additional information

Communicated by Jaan Toelen

Electronic supplementary material

ESM 1

The intra- and inter-observer plots for MAD and TAD mid (in millimeters) - The intra-observer analyses (left) were reviewed by KY twice 6 months apart. The inter-observer analyses (right) were independently reviewed by 2 investigators (KY and TP). The bold horizontal line represents the mean difference. The dashed horizontal lines represent ±1.96 SD from the mean between the 2 measurements. (EPS 1073 kb) (GIF 153 kb)

High-resolution image (EPS 1073 kb)

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Ylänen, K., Eerola, A., Vettenranta, K. et al. Speckle tracking echocardiography detects decreased cardiac longitudinal function in anthracycline-exposed survivors of childhood cancer. Eur J Pediatr 175, 1379–1386 (2016). https://doi.org/10.1007/s00431-016-2776-9

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  • DOI: https://doi.org/10.1007/s00431-016-2776-9

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