Improved Cardiomyopathy Risk Prediction Using Global Longitudinal Strain and N-Terminal-Pro-B-Type Natriuretic Peptide in Survivors of Childhood Cancer Exposed to Cardiotoxic Therapy

Author:

Ehrhardt Matthew J.12ORCID,Liu Qi3ORCID,Mulrooney Daniel A.12ORCID,Rhea Isaac B.4ORCID,Dixon Stephanie B.12ORCID,Lucas John T.5ORCID,Sapkota Yadav2ORCID,Shelton Kyla2ORCID,Ness Kirsten K.2ORCID,Srivastava Deo Kumar6ORCID,McDonald Aaron2ORCID,Robison Leslie L.2ORCID,Hudson Melissa M.12ORCID,Yasui Yutaka2ORCID,Armstrong Gregory T.2

Affiliation:

1. Department of Oncology, St Jude Children's Research Hospital, Memphis, TN

2. Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN

3. Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada

4. Department of Medicine, University of Tennessee Health Science Center, Memphis, TN

5. Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, TN

6. Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN

Abstract

PURPOSE To leverage baseline global longitudinal strain (GLS) and N-terminal-pro-B-type natriuretic peptide (NT-proBNP) to identify childhood cancer survivors with a normal left ventricular ejection fraction (LVEF) at highest risk of future treatment-related cardiomyopathy. METHODS St Jude Lifetime Cohort participants ≥5 years from diagnosis, at increased risk for cardiomyopathy per the International Guideline Harmonization Group (IGHG), with an LVEF ≥50% on baseline echocardiography (n = 1,483) underwent measurement of GLS (n = 1,483) and NT-proBNP (n = 1,052; 71%). Multivariable Cox regression models estimated hazard ratios (HRs) and 95% CIs for postbaseline cardiomyopathy (modified Common Terminology Criteria for Adverse Events ≥grade 2) incidence in association with echocardiogram-based GLS (≥–18) and/or NT-proBNP (>age-sex-specific 97.5th percentiles). Prediction performance was assessed using AUC in models with and without GLS and NT-proBNP and compared using DeLong's test for IGHG moderate- and high-risk individuals treated with anthracyclines. RESULTS Among survivors (median age, 37.6; range, 10.2-70.4 years), 162 (11.1%) developed ≥grade 2 cardiomyopathy 5.1 (0.7-10.0) years from baseline assessment. The 5-year cumulative incidence of cardiomyopathy for survivors with and without abnormal GLS was, respectively, 7.3% (95% CI, 4.7 to 9.9) versus 4.4% (95% CI, 3.0 to 5.7) and abnormal NT-proBNP was 9.9% (95% CI, 5.8 to 14.1) versus 4.7% (95% CI, 3.2 to 6.2). Among survivors with a normal LVEF, abnormal baseline GLS and NT-proBNP identified anthracycline-exposed, IGHG-defined moderate-/high-risk survivors at a four-fold increased hazard of postbaseline cardiomyopathy (HR, 4.39 [95% CI, 2.46 to 7.83]; P < .001), increasing to a HR of 14.16 (95% CI, 6.45 to 31.08; P < .001) among survivors who received ≥250 mg/m2 of anthracyclines. Six years after baseline, AUCs for individual risk prediction were 0.70 for models with and 0.63 for models without GLS and NT-proBNP ( P = .022). CONCLUSION GLS and NT-proBNP should be considered for improved identification of survivors at high risk for future cardiomyopathy.

Publisher

American Society of Clinical Oncology (ASCO)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Natriuretic Peptides and Troponins;JACC: CardioOncology;2024-04

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