Comprehensive Echocardiographic Detection of Treatment-Related XXXX in Adult Survivors of  Childhood Cancer: Results From the St. Jude Lifetime Cohort Study.

@entity296 @entity66 @entity5 @entity5948 @entity299 @entity209 @entity204
BACKGROUND: Treatment-related @entity204 is the primary, noncancer cause of mortality in adult survivors of childhood @entity5 . Early detection of @entity299 may identify a high-risk subset of survivors for early intervention. OBJECTIVES: This study sought to determine the prevalence of @entity299 in adult survivors of childhood @entity5 . METHODS: Echocardiographic assessment included 3-dimensional (3D) left ventricular ejection fraction (LVEF), global longitudinal and circumferential @entity296 , and diastolic function, graded per American Society of Echocardiography guidelines in 1,820 adult (median age 31 years; range: 18 to 65 years) survivors of childhood @entity5 (median time from diagnosis 23 years; range: 10 to 48 years) exposed to @entity5948 chemotherapy (n  = 1,050), chest-directed radiotherapy (n  = 306), or both (n  = 464). RESULTS: Only 5.8% of survivors had abnormal 3D LVEFs (<50%). However, 32.1% of survivors with normal 3D LVEFs had evidence of @entity299 by global longitudinal strain (28%), American Society of Echocardiography-graded diastolic assessment (8.7%), or both. @entity66 was associated with chest-directed radiotherapy at 1 to 19.9 Gy (rate ratio [RR]: 1.38; 95% confidence interval [CI]: 1.14 to 1.66), 20 to 29.9 Gy (RR: 1.65; 95% CI:  1.31 to 2.08), and >30 Gy (RR: 2.39; 95% CI: 1.79 to 3.18) and @entity5948 dose > 300 mg/m(2) (RR: 1.72; 95% CI: 1.31 to  2.26). Survivors with @entity209 were twice as likely to have @entity66 (RR: 1.94; 95% CI: 1.66 to 2.28) and abnormal diastolic function (RR: 1.68; 95% CI: 1.39 to 2.03) but not abnormal 3D LVEFs (RR:  1.07; 95% CI: 0.74 to 1.53). CONCLUSIONS: @entity66 and diastolic function are more prevalent than reduced 3D LVEF and are associated with treatment exposure. They may identify a subset of survivors at higher risk for poor clinical cardiac outcomes who may benefit from early medical intervention.
