SURVIVORS of childhood cancer with abnormal baseline longitudinal strain (GLS) and N-terminal pro B-type natriuretic peptide (NT-proBNP) have an increased risk of developing cardiomyopathy, according to recent findings.
Lead study author Matthew J. Erhardt, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA, and colleagues, conducted a retrospective study of 1,483 patients from the St. Jude Lifetime Cohort (SJLIFE) longitudinal prospective study who had survived ≥5 years from cancer diagnosis, and had ≥50% left ventricular ejection fraction on baseline echocardiography (median age: 37.6 years; range: 10.2–70.4). A total of 1,483 patients underwent GLS measurement, and 1,052 underwent NT-proBNP measurement.
Of the 1,483 survivors of childhood cancer included in the study, 162 (11.1%) developed Grade 2 or greater cardiomyopathy 5.1 years from time of baseline assessment. The 5-year cumulative incidence of cardiomyopathy for survivors with abnormal GLS was 7.3% (95% confidence interval [CI]: 4.7–9.9), and 4.4% without abnormal GLS (95% CI: 3.0–5.7). The 5-year cumulative incidence of cardiomyopathy for survivors with abnormal NT-proBNP was 9.9% (95% CI: 5.8–14.1), and 4.7% without abnormal NT-proBNP (95% CI: 3.2–6.2).
Furthermore, among survivors with a normal left ventricular ejection fraction, abnormal baseline GLS and NT-proBNP identified anthracycline-exposed, International Guideline Harmonization Group (IGHG)-defined moderate-to-high-risk patients at a four-fold increased hazard for postbaseline cardiomyopathy (hazard ratio: 4.39; 95% CI: 2.46–7.83; P<0.001). This risk increased to more than 14-fold (hazard ratio: 14.16; 95% CI: 6.45–31.08; P<0.001) among patients who received ≥250 mg/m2 of anthracyclines.
The study concluded that GLS and NT-proBNP should be considered as biomarkers for predicting cardiomyopathy among asymptomatic survivors of childhood cancer who might benefit from intervention at an earlier stage. “We were somewhat surprised by the magnitude of risk for declining heart function over such a relatively short period in individuals with abnormal GLS and NT-proBNP, suggesting a need for early and effective interventions that we hope will prevent progression to heart failure over time,” noted Erhardt. He added that GLS and NT-proNBP tests are readily available to most cardiologists, so the study findings have the potential to impact care more immediately.
