Natural shear wave velocities at rest are associated with impaired cardiopulmonary fitness in childhood cancer survivors.
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BACKGROUND: Childhood cancer survivors (CCS) may face hidden cardiotoxicity undetectable by conventional echocardiography, yet may be related to the impaired cardiopulmonary fitness (CPF) commonly observed in CCS. High frame rate (HFR) echocardiography captures natural myocardial shear waves (SW) after mitral valve closure (MVC), providing insights into myocardial stiffness (MS), one of the main determinants of diastolic function. This study explores cardiac function including SW velocities in CCS compared to healthy peers and its relation to CPF (VO2peak). METHODS: We enrolled 142 participants, including 77 asymptomatic CCS (median age: 19 years [IQR: 16,22]) and 65 age and sex matched healthy volunteers (HV). All participants underwent resting conventional and HFR echocardiography, followed by an incremental, symptom-limited cardiopulmonary exercise test on a treadmill to determine VO2peak. Based on exercise performance, CCS and HV were subsequently classified as fit or non-fit. RESULTS: In our CCS cohort (mean time since treatment: 5.0 ±2.9 years), 9.1 % had mildly reduced ejection fraction and 14.3 % impaired global longitudinal strain. However, neither correlated with VO2peak (p>0.05), however, GLS showed modest correlation with VO2peak standardized to age, sex, and weight (% predicted VO2peak). Among diastolic indices, E-wave deceleration time (DT) was shorter in non-fit CCS versus fit-CCS and HV (P<0.001) and correlated with the % predicted VO2peak in CCS cohort (r=0.6, p<0.001). Interestingly, SW velocities after MVC were significantly higher in non-fit CCS than in fit CCS, fit HV and non-fit HV (4.1 ±0.5 vs 3.3 ±0.3 vs 3.2 ±0.3 vs 3.4±0.2 m/s respectively; p<0.001)). Additionally, SW velocities strongly correlated with VO2peak (% predicted) (r=-0.74, p< 0.001), and could predict impaired CPF with 90% accuracy in CCS. CONCLUSION: Our findings suggest that resting SW velocities may sensitively indicate increased MS and subclinical cardiac dysfunction, helping to explain impaired CPF in CCS. Natural SW imaging could have added value in assessing cardiac function and CPF within cardio-oncology, though further studies are needed to confirm its role.