Childhood Cancer Survivors Have Impaired Strain-Derived Myocardial Contractile Reserve by Dobutamine Stress Echocardiography

Abnormal left ventricular contractile reserve (LVCR) is associated with adverse cardiac outcomes in different patient cohorts and might be useful in the detection of cardiomyopathy in childhood cancer survivors (CCS) after cardiotoxic treatment. The aim of this study was to evaluate LVCR by dobutamine stress echocardiography (DSE) combined with measures of myocardial strain in CCS previously treated with anthracyclines (AC). Fifty-three CCS (age 25.34 +/- 2.44 years, 35 male) and 53 healthy controls (age 24.40 +/- 2.40 years, 32 male) were included. Subjects were examined with echocardiography at rest, at low-dose (5 micrograms/kg/min), and at high-dose (40 micrograms/kg/min) dobutamine infusion. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), strain rate (GSR), and early diastolic strain rate (GEDSR) at different DSE phases were used as measures of LVCR. The mean follow-up time among CCS was 15.8 +/- 5.8 years. GLS, GSR, and LVEF were lower at rest in CCS compared to controls (p <= 0.03). LVEF was within the normal range in CCS. Delta GLS, Delta GSR, and Delta GEDSR but not Delta LVEF were lower in CCS compared to controls after both low- (p <= 0.048) and high-dose dobutamine infusion (p <= 0.023). We conclude that strain measures during low-dose DSE detect impaired myocardial contractile reserve in young CCS treated with AC at 15-year follow-up. Thus, DSE may help identify asymptomatic CCS at risk for heart failure and allows for tailored follow-up accordingly.

Automated summary

This study aimed to evaluate the feasibility of using dobutamine stress echocardiography (DSE) combined with myocardial strain measurements to assess left ventricular contractile reserve in childhood cancer survivors who received cardiotoxic treatment. The results showed that DSE detected impaired myocardial contractile reserve in patients treated with anthracyclines during a 15-year follow-up. Therefore, DSE can help identify asymptomatic cancer survivors at risk for heart failure and guide appropriate follow-up.