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Correlating decline in left ventricular ejection fraction and longitudinal strain in pediatric cancer patients

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Abstract

Purpose

Left ventricular ejection fraction (LVEF) is routinely used to monitor cardiac function in cancer patients. Global longitudinal strain (GLS) detects subclinical myocardial dysfunction. There is no consensus on what constitutes a significant change in GLS in pediatric cancer patients. We aim to determine the change in GLS associated with a simultaneous decline in LVEF in pediatric cancer patients.

Methods

This is a retrospective longitudinal study of pediatric cancer patients treated with anthracyclines between October 2017 and November 2019. GLS was measured by 2-dimensional speckle tracking. The study outcome was a decline in LVEF, defined as a decrease in LVEF of ≥ 10% points from baseline or LVEF < 55%. We evaluated two echocardiograms per patient, one baseline, and one follow-up. The follow-up echocardiogram was either (1) the first study that met the outcome or (2) the last echocardiogram available in patients without the outcome. Statistical analyses included receiver operator characteristic curves and univariable and multivariable Cox proportional hazards regression.

Results

Out of 161 patients, 33 (20.5%) had a decline in LVEF within one year of follow-up. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% had sensitivities of 85% and 78%, respectively, and specificities of 86% and 83%, respectively, to detect LVEF decline. GLS reduction by ≥ 15% from baseline and follow-up GLS >-18% were independently associated with simultaneous LVEF decline [hazard ratio (95% confidence intervals): 16.71 (5.47–51.06), and 12.83 (4.62–35.63), respectively].

Conclusion

Monitoring GLS validates the decline in LVEF in pediatric cancer patients.

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Abbreviations

CTRCD :

Cancer therapy-related cardiac dysfunction

LV :

Left ventricular

LVEF :

Left ventricular ejection fraction

GLS :

Global longitudinal strain

IQR :

Interquartile range

ROC :

receiver operating characteristic

AUC :

Area under the curve

CI :

Confidence interval

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, 6651 Main St. Suite E1920, 77030, Houston, TX, USA

    Aura A Sanchez Mejia, Ricardo H Pignatelli, Christian Lilje, Shagun Sachdeva, Hari P Tunuguntla & Tam T Doan

  2. Texas Children’s Hospital, 6621 Fannin St, 77030, Houston, TX, USA

    Aura A Sanchez Mejia, Ricardo H Pignatelli, Nino Rainusso, Christian Lilje, Shagun Sachdeva, Hari P Tunuguntla & Tam T Doan

  3. Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine Feigin Center, 1102 Bates St., Suite 1030.07, 77030, Houston, TX, USA

    Nino Rainusso

  4. Baylor College of Medicine, One Baylor Plaza, 77030, Houston, TX, USA

    Anusha A Gandhi & Nicole C Walters

  5. Boston University, 64 Cummington Mall, room 149, 02215, Boston, MA, USA

    Daniela Plana Trajtenberg

  6. Cook Children’s Medical Center, 801 7th Ave, 76104, Fort Worth, TX, USA

    Robert W Loar

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Contributions

Aura A. Sanchez Mejia, Ricardo H. Pignatelli, Nino Rainusso, Christian Lilje, Shagun Sachdeva, Hari P Tunuguntla, Tam T Doan, and Robert W Loar made substantial contributions to the conception and design of this work. Aura A. Sanchez Mejia, Anusha A Gandhi, Nicole C Walters, and Daniela Plana Trajtenberg collected clinical and echocardiographic data. AASM and RWL performed the statistical analyses. AASM drafted the mansucript which was then critically reviewed, revised, and approved by all authors.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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The authors have no relevant financial or non-financial interests to disclose.

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This research study was conducted retrospectively from data obtained for clinical purposes. This study was performed with approval by the Institutional Review Board for Baylor College of Medicine. Waiver of patient consent was granted by the Institutional Review Board for Baylor College of Medicine.

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Sanchez Mejia, A.A., Pignatelli, R.H., Rainusso, N. et al. Correlating decline in left ventricular ejection fraction and longitudinal strain in pediatric cancer patients. Int J Cardiovasc Imaging 39, 747–755 (2023). https://doi.org/10.1007/s10554-022-02780-z

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