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Two-Dimensional Speckle Tracking Echocardiography-Derived Strain Measurements in Survivors of Childhood Cancer on Angiotensin Converting Enzyme Inhibition or Receptor Blockade

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Abstract

Speckle tracking echocardiography (STE)-derived strain indices are believed to detect early cardiac dysfunction in survivors of childhood cancer and have potential to identify patients who may benefit from early heart failure treatment. However, effects of heart failure treatment on STE-derived strain measurements in this population are unknown. The aim of this study was to assess STE-derived strain measurements in survivors of childhood cancer treated with angiotensin converting enzyme inhibition or receptor blockade (ACEi/ARB). Two-dimensional speckle tracking analysis was retrospectively performed on echocardiograms from childhood cancer survivors before and during therapy with ACEi/ARB. Global left ventricular longitudinal and circumferential strain (GLS and GCS) and strain rates (LSR and CSR) were assessed and correlated with conventional echocardiographic measures of function. In 22 childhood cancer survivors (median age: 14.8, range 6.4–21.6 years), mean GLS (− 13.83 ± 0.74% to − 15.94 ± 0.74%, p = 0.002), GCS (− 18.79 ± 1.21% to − 20.74 ± 0.84%, p = 0.027), LSR (− 0.78 ± 0.04 to − 0.88 ± 0.04 s−1, p = 0.022), and CSR (− 1.08 ± 0.07 to − 1.21 ± 0.06 s−1, p = 0.027) improved on therapy. Improvement in GLS was maintained for greater than 1 year on ACEi/ARB (p = 0.02). Measures of strain and strain rate correlated with standard echocardiographic measures of function and were reproducible. These findings support the use of ACEi/ARB to treat post-chemotherapy-related cardiovascular changes in childhood cancer survivors, provide proof-of-concept that STE-derived strain and strain rate may be used to reliably monitor cardiac function during therapy, and support continued investigation into the clinical benefit of strain measurements in this population.

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Acknowledgements

Grant funding was generously provided by Matthew’s Hearts of Hope Inc., Sherman, CT.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, College of Physicians & Surgeons, Columbia University Medical Center, 3959 Broadway, CHN 2-255, New York, NY, 10032, USA

    Jamie K. Harrington, Marc E. Richmond & Amee Shah

  2. College of Physicians & Surgeons, Columbia University Medical Center, New York, NY, USA

    Arielle W. Fein

  3. Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, NY, USA

    Serge Kobsa

  4. Division of Hematology/Oncology/Stem Cell Transplantation, Department of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY, USA

    Prakash Satwani

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  1. Jamie K. Harrington
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Correspondence to Amee Shah.

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Harrington, J.K., Richmond, M.E., Fein, A.W. et al. Two-Dimensional Speckle Tracking Echocardiography-Derived Strain Measurements in Survivors of Childhood Cancer on Angiotensin Converting Enzyme Inhibition or Receptor Blockade. Pediatr Cardiol 39, 1404–1412 (2018). https://doi.org/10.1007/s00246-018-1910-z

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