Echocardiographic parameters and risk factors for cardiomyopathy in Japanese childhood cancer survivors: A report from St. Luke's lifetime cohort study.
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BACKGROUND: Cardiac dysfunction is a life-threatening late complication among childhood cancer survivors (CCSs), with incidence rates only increasing over time, highlighting the importance of long-term follow-up. Nevertheless, detailed investigations in Japanese CCSs have been lacking. METHODS: This study targeted CCSs aged 18 years or older who were diagnosed with childhood cancer ≥10 years prior to recruitment and survived without cancer for ≥5 years, and included their siblings. CCSs were divided into two groups: those with cancer therapy-related cardiac dysfunction (CTRCD) [left ventricular ejection fraction (LVEF) ≤53 %] and those without CTRCD. We analyzed cardiac function and investigated the risk factors for CTRCD. The cut-off value for the total cumulative dose of anthracycline that induced CTRCD was determined using the receiver operating characteristic curve. RESULTS: A total of 108 CCSs (median age, 25 years) and 26 siblings (median age, 23 years) were included in the analysis. Among the CCSs, 15 (14 %) were classified as having CTRCD (mean LVEF, 51.9 % ± 4.7 %). The CTRCD group exhibited a significantly decreased left ventricular global longitudinal strain (mean, 18.4 ± 2.9 %; p < 0.01). In particular, local strain values at the basal septal (p = 0.03), anteroseptal (p < 0.01), and mid anteroseptal (p = 0.03) segments were significantly reduced. A cumulative anthracycline dose exceeding 150 mg/m2 significantly increased the risk of developing CTRCD (p < 0.01). CONCLUSIONS: Given that 14 % of CCSs developed cardiomyopathy during young adulthood, regular follow-up observations, especially among those who received anthracycline >150 mg/m2, are imperative.