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Left atrial function in children and young adult cancer survivors treated with anthracyclines
Author(s) -
Patel Nisha R.,
Chyu Christopher K.,
Satou Gary M.,
Hal Nancy J.,
Nguyen KimLien
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14100
Subject(s) - anthracycline , medicine , ejection fraction , cardiology , heart failure , cumulative dose , speckle tracking echocardiography , heart rate , body surface area , cancer , blood pressure , breast cancer
Background The left atrium (LA) modulates left ventricular filling pressure and is a strong prognosticator in heart failure. Although anthracycline exposure may lead to impaired left ventricular (LV) function, the effects on LA function are not well‐described in the younger population. We aim to evaluate LA function in children exposed to anthracyclines. Methods Children exposed to anthracyclines with pre‐ and post‐treatment echocardiographic imaging were enrolled. Measures of LA function (LA ejection fraction [LA EF], global longitudinal strain [GLS], and peak GLS rate) were quantified using 2D speckle tracking echocardiography pre‐ and post‐anthracycline therapy and were compared. Segments with poor tracking were excluded. Results Fifty‐five children (age 13 [SD 5] years) treated with anthracyclines were evaluated. LA EF, GLS, and peak GLS rate were lower after anthracycline exposure. Mean changes were as follows: LA EF (pre‐73.5 [SD 7.7]% vs post‐70.6 [SD 8.2]%, P = 0.06), GLS (−34.2 [SD 8.4]% vs −31.9 [SD 7.1]%, P = 0.09), peak GLS rate (2.2 [SD 0.8] s −1 vs 2.0 [SD 0.6] s −1 , P = 0.18). When stratified by pre‐ (≤12 years old) vs post‐puberty (>12 years old), prepubescent patients (n = 21) had statistically significant changes in pre/post LA GLS ( P = 0.01) and LA EF ( P = 0.01). In models adjusted for radiation dose, age, gender, body surface area, or cumulative anthracycline dose, there were no significant relationships in the absolute difference between pre/post LA EF ( P = 0.34) or LA GLS ( P = 0.18). Conclusions In children exposed to anthracyclines, short‐term effects on LA function were minimal in those with preserved LV EF. Age‐dependent LA susceptibility to anthracycline requires further study.