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Impaired exercise capacity and left ventricular function in long‐term adult survivors of childhood acute lymphoblastic leukemia
Author(s) -
Christiansen Jon R.,
Kanellopoulos Adriani,
Lund May B.,
Massey Richard,
Dalen Håvard,
Kiserud Cecilie E.,
Ruud Ellen,
Aakhus Svend
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.25492
Subject(s) - medicine , anthracycline , bayesian multivariate linear regression , cardiology , cumulative dose , diastole , multivariate analysis , cancer , linear regression , breast cancer , blood pressure , machine learning , computer science
Background Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for late cardiotoxic effects of cancer treatment, but conflicting evidence exists on the effects of anthracyclines on left ventricular (LV) diastolic function and exercise capacity. Procedure We performed a cross‐sectional study with comprehensive echocardiography in 138 adult survivors of childhood ALL, median 23.4 years after diagnosis. Pulsed tissue Doppler measurements of early diastolic mitral annular velocities (e’) were used for the assessment of diastolic function, and compared to 138 matched controls. Of the survivors, 133 also performed ergospirometry measuring peak oxygen uptake (VO 2 max). Associations between cancer treatment, LV function, and VO 2 max were analyzed. Results The survivor group had lower e’ values than controls (e’ septal 11.0 vs. 12.6 cm/s, P < 0.001), but the difference was confined to the subgroup of anthracycline treated survivors (median cumulative dose 120 mg/m 2 ). Anthracycline exposure was inversely correlated with e’ (regression coefficient −1.581, P = 0.009). Reduced VO 2 max/kg occurred in 47% of the survivors, but more often in anthracycline treated survivors (56%) than anthracycline naïve survivors (17%, P < 0.001). Anthracycline exposure was inversely correlated with VO 2 max/kg (regression coefficient −3.084, P = 0.05 in multivariate analysis). Furthermore, associations were observed between measures of LV function and VO 2 max/kg, and e’ was the best predictor of VO 2 max/kg (standardized coefficient 0.355, P < 0.001 in multivariate analysis). Conclusions Adult survivors of childhood ALL have increased risk for impaired LV diastolic function and impaired exercise capacity, both associated with previous anthracycline exposure. Furthermore, there is an association between LV diastolic function and exercise capacity. Pediatr Blood Cancer 2015;62:1437–1443. © 2015 Wiley Periodicals, Inc.