Obesity Predisposes Anthracycline-Treated Survivors of Childhood and Adolescent Cancers to Subclinical Cardiac Dysfunction.
| Title: | Obesity Predisposes Anthracycline-Treated Survivors of Childhood and Adolescent Cancers to Subclinical Cardiac Dysfunction. |
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| Authors: | George IA; Duke University School of Medicine, Durham, NC, USA.; Souder B; Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.; Berkman A; Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.; Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.; Noyd DH; Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.; Seattle Children's Hospital, Seattle, WA, USA.; Jay Campbell M; Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.; Barker PCA; Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.; Roth M; Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Hildebrandt MAT; Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.; Oeffinger KC; Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC, USA.; McCrary AW; Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA. andrew.mccrary@duke.edu.; Duke University Medical Center, Box 3090, Durham, NC, 27710, USA. andrew.mccrary@duke.edu.; Landstrom AP; Duke Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA. andrew.landstrom@duke.edu.; Duke University Medical Center, Box 2652, Durham, NC, 27710, USA. andrew.landstrom@duke.edu. |
| Source: | Pediatric cardiology [Pediatr Cardiol] 2025 Feb; Vol. 46 (2), pp. 362-371. Date of Electronic Publication: 2024 Mar 08. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Springer Verlag Country of Publication: United States NLM ID: 8003849 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1971 (Electronic) Linking ISSN: 01720643 NLM ISO Abbreviation: Pediatr Cardiol Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York Ny : Springer Verlag; Original Publication: [New York, Springer-Verlag] |
| MeSH Terms: | Anthracyclines*/adverse effects ; Anthracyclines*/therapeutic use ; Neoplasms*/drug therapy ; Cardiotoxicity*/etiology ; Obesity*/complications ; Pediatric Obesity*/complications ; Antibiotics, Antineoplastic*/adverse effects ; Cancer Survivors*; Humans ; Female ; Child ; Adolescent ; Male ; Echocardiography ; Retrospective Studies ; Risk Factors ; Child, Preschool |
| Abstract: | Anthracyclines are effective chemotherapeutics used in approximately 60% of pediatric cancer cases but have a well-documented risk of cardiotoxicity. Existing cardiotoxicity risk calculators do not include cardiovascular risk factors present at the time of diagnosis. The goal of this study is to leverage the advanced sensitivity of strain echocardiography to identify pre-existing risk factors for early subclinical cardiac dysfunction among anthracycline-exposed pediatric patients. We identified 115 pediatric patients with cancer who were treated with an anthracycline between 2013 and 2019. Peak longitudinal left ventricular strain was retroactively calculated on 495 surveillance echocardiograms via the TOMTEC AutoSTRAIN software. Cox proportional hazards models were employed to identify risk factors for abnormal longitudinal strain (> - 16%) following anthracycline treatment. High anthracycline dose (≥ 250 mg/m2 doxorubicin equivalents) and obesity at the time of diagnosis (BMI > 95th percentile-for-age) were both significant predictors of abnormal strain with hazard ratios of 2.79, 95% CI (1.07-7.25), and 3.85, 95% CI (1.42-10.48), respectively. Among pediatric cancer survivors, patients who are obese at the time of diagnosis are at an increased risk of sub-clinical cardiac dysfunction following anthracycline exposure. Future studies should explore the incidence of symptomatic cardiomyopathy 10-15 years post-treatment among patients with early subclinical cardiac dysfunction.; (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.) |
| Competing Interests: | Declarations. Competing Interests: There are no competing interests to disclose. |
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| Grant Information: | R38-HL143612 United States NH NIH HHS; R01 HL160654 United States HL NHLBI NIH HHS; TL1-TR002555 United States NH NIH HHS; R01 HL166217 United States HL NHLBI NIH HHS; P30 CA016672 United States NH NIH HHS; R01-HL160654 United States NH NIH HHS; R38 HL143612 United States HL NHLBI NIH HHS; TL1 TR002555 United States TR NCATS NIH HHS; P30 CA016672 United States CA NCI NIH HHS |
| Contributed Indexing: | Keywords: Anthracycline; Cardiomyopathy; Cardiotoxicity; Heart failure; Pediatric; Strain echocardiography |
| Substance Nomenclature: | 0 (Anthracyclines); 0 (Antibiotics, Antineoplastic) |
| Entry Date(s): | Date Created: 20240308 Date Completed: 20250422 Latest Revision: 20260202 |
| Update Code: | 20260202 |
| PubMed Central ID: | PMC11380701 |
| DOI: | 10.1007/s00246-024-03423-x |
| PMID: | 38456890 |
| Database: | MEDLINE |
Journal Article