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New insight into the intraventricular pressure gradient as a sensitive indicator of diastolic cardiac dysfunction in patients with childhood cancer after anthracycline therapy

  • Sachie Shigemitsu
  • Ken TakahashiEmail author
  • Kana Yazaki
  • Maki Kobayashi
  • Mariko Yamada
  • Katsumi Akimoto
  • Hiroyuki Tamaichi
  • Junya Fujimura
  • Masahiro Saito
  • Masaki Nii
  • Keiichi Itatani
  • Toshiaki Shimizu
Original Article
  • 22 Downloads

Abstract

Cardiac dysfunction due to cardiotoxicity from anthracycline chemotherapy is a leading cause of morbidity and mortality in survivors of childhood cancer. The intraventricular pressure gradient (IVPG) of the left ventricle (LV) is the suction force of blood from the left atrium to the LV apex during early diastole and is a sensitive indicator of diastolic function. We assessed IVPG as a new indicator of the cardiac dysfunction in survivors of childhood cancer after anthracycline therapy. We performed a prospective echocardiographic study on 40 survivors of childhood cancer aged 6–26 years who received anthracycline therapy (group A) and 53 similar-age normal controls (group N). The subjects were divided into the younger groups, N1 and A1 (age < 16 years); older groups, N2 and A2 (age ≥ 16 years). IVPG was calculated using color M-mode Doppler imaging of the mitral inflow using Euler’s equation. Total IVPG was divided into the basal and mid-to-apical IVPG to demonstrate more clearly the mechanisms of the LV diastolic suction force. The total anthracycline dose was 16.2–600.0 mg/m2 (median 143.5 mg/m2). Total IVPG significantly decreased in group A2 compared with that in group N2 (0.39 ± 0.07 vs. 0.29 ± 0.11 mmHg/cm; p = 0.010). The mid-to-apical IVPG significantly decreased in groups A1 and A2 compared with that in groups N1 and N2, respectively (N1 vs. A1: 0.20 ± 0.05 vs. 0.16 ± 0.05 mmHg/cm, p = 0.036; N2 vs. A2: 0.21 ± 0.06 vs. 0.14 ± 0.06 mmHg/cm, p = 0.001). Basal IVPG, E wave, and E/e′ were not significantly different between patients and normal controls. The total and mid-to-apical IVPG, especially mid-to-apical IVPG, could be sensitive new indicators in survivors of childhood cancer after anthracycline therapy.

Keywords

Intraventricular pressure gradient Childhood cancer Anthracycline Cardiotoxicity Diastolic function 

Notes

Acknowledgements

We thank the staff of Shizuoka Children’s Hospital for collecting the echocardiographic data of children and adults with no cardiac defects (healthy group).

Compliance with ethical standards

Conflict of interest

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Supplementary material

380_2018_1332_MOESM1_ESM.docx (24 kb)
Supplementary file1 (DOCX 24 kb)

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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  • Sachie Shigemitsu
    • 1
    • 2
  • Ken Takahashi
    • 1
    Email author
  • Kana Yazaki
    • 1
  • Maki Kobayashi
    • 1
  • Mariko Yamada
    • 1
  • Katsumi Akimoto
    • 1
  • Hiroyuki Tamaichi
    • 1
  • Junya Fujimura
    • 1
  • Masahiro Saito
    • 1
  • Masaki Nii
    • 3
  • Keiichi Itatani
    • 4
  • Toshiaki Shimizu
    • 1
  1. 1.Department of Pediatrics, Faculty of MedicineJuntendo UniversityTokyoJapan
  2. 2.Department of PediatricsKawasaki Kyodo HospitalKawasaki-ku, Kawasaki-cityJapan
  3. 3.Department of CardiologyShizuoka Children’s HospitalShizuoka-city, ShizuokaJapan
  4. 4.Department of Cardiovascular Surgery, Cardiovascular Imaging Research LaboratoryKyoto Prefectural University of MedicineKyoto-city, KyotoJapan

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