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Myocardial iron load and fibrosis in long term survivors of childhood leukemia
Author(s) -
Cheung Yiufai,
Lam Wendy Waiman,
Ip Janice JingKun,
Cheuk Daniel Kaleung,
Cheng Frankie Waitsoi,
Yang Janet Yeekwan,
Yau Jeffrey Pingwa,
Ho Karin Kahuen,
Li Chikong,
Li Rever Chakho,
Yuen Huileung,
Ling Alvin Siucheung,
Li Vivian Wingyi,
Chan Godfrey Chifung
Publication year - 2015
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.25369
Subject(s) - medicine , cardiology , myocardial fibrosis , ejection fraction , diastole , fibrosis , doppler echocardiography , doppler imaging , heart failure , blood pressure
Background We sought to assess myocardial iron load and fibrosis, which may potentially affect cardiac function, in adult survivors of childhood leukemias and their relationships with left (LV) and right ventricular (RV) function. Procedure Fifty‐eight (33 males) adult survivors, aged 24.5 ± 4.4, underwent cardiac magnetic resonance (CMR) at 16.6 ± 5.8 years after completion of treatment. Myocardial iron load and fibrosis were quantified using respectively T2* scan and late gadolinium enhancement. Right and left ventricular ejection fraction (EF) was measured by CMR, while myocardial function was assessed using tissue Doppler imaging. Results None of the survivors had significant myocardial iron overload (T2*<20 msec). The prevalence of LV and RV fibrosis was 9% (5/58) and 38% (22/58), respectively. Left ventricular EF was subnormal (EF 45–<55%) in 9% (5/58), while RV EF was abnormal (EF <45%) in 12% (7/58) and subnormal in 34% (20/58) of survivors. Patients with LV fibrosis had significantly lower mitral annular early diastolic velocity ( P = 0.01) and smaller LV end‐systolic volume ( P = 0.02), while those with RV fibrosis had significantly lower tricuspid late diastolic annular velocity ( P = 0.02) and early to late diastolic annular velocity ratio ( P = 0.02) compared to those without. Cumulative anthracycline dose correlated with early diastolic mitral (r = −0.28, P = 0.038) and tricuspid (r = −0.40, P = 0.002) annular velocities, but not LV and RV EF or fibrosis (all P > 0.05). Conclusion Ventricular fibrosis may occur in long term survivors of childhood leukemias and is related to diastolic function in the absence of significant myocardial iron overload. Pediatr Blood Cancer 2015;62:698–703. © 2015 Wiley Periodicals, Inc.