Longitudinal echocardiographic monitoring and cardiovascular outcomes in adult survivors of childhood cancer

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BACKGROUND: Adult survivors of childhood cancers are thought to be at high risk for late-onset cardiovascular complications of prior anti-cancer treatments. While cancer therapy-related cardiac dysfunction (CTRCD) has previously been observed in this population, data are limited regarding the utility of longitudinal echocardiographic monitoring. METHODS: 124 adult survivors of childhood cancer who were previously treated with anthracyclines and/or radiation therapy as children were included in this longitudinal cohort study. Participants were enrolled in Northwestern Medicine's survivorship clinic: Survivors Taking Action and Responsibility (STAR) Program and followed for up to10 years between 2009 and 2022. Serial echocardiography was performed at baseline then at 1, 3, 5, and 7-10 years post-enrollment. Clinical data was collected by chart review. Major adverse cardiovascular events (MACE) and CTRCD were adjudicated according to ACC/AHA MACE criteria and the ESC Cardio-Oncology guidelines respectively. RESULTS: Over 10 years of follow-up in the STAR Program, 17.7% (22/124) of participants developed MACE, with the highest incidence observed in patients treated with radiation alone. 10.5% (13/124) of patients developed CTRCD by left ventricular ejection fraction (LVEF) criteria while 36.3% (45/124) developed CTRCD by global longitudinal strain (GLS) criteria. New incidence of MACE and CTRCD occurred as late as 7-10 years post-enrollment. Participants who developed CTRCD showed subsequent improvement in both LVEF and GLS by the end of 10 years of follow-up and treatment in the STAR Program. CONCLUSIONS: Survivors of childhood cancer are at high risk for both MACE and CTRCD even many years after initial diagnosis. Patients who received treatment for pediatric cancer, then subsequently enrolled in the STAR Program as adults and received appropriate cardiovascular monitoring and treatment showed improvement in both LVEF and GLS by the end of follow-up, underscoring the importance of a dedicated survivorship clinic for adult survivors of pediatric cancer.

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