Prevalence of Diastolic Dysfunction in Adult Survivors of Childhood Cancer: A Report From SJLIFE Cohort

Abstract Background The prevalence of diastolic dysfunction has not been systematically evaluated in a large population of survivors of childhood cancer using established guidelines and standards. Objectives This study sought to assess the prevalence and progression of diastolic dysfunction in adult survivors of childhood cancer exposed to cardiotoxic therapy. Methods Comprehensive, longitudinal echocardiographic examinations of adult survivors of childhood cancer ≥18 years of age and ≥10 years from diagnosis in SJLIFE (St. Jude Lifetime Cohort Study) were performed. Diastolic dysfunction was defined based on 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Results Among 3,342 survivors, the median (25th-75th percentiles [quartile (Q)1-Q3]) age at diagnosis was 8.1 years (Q1-Q3: 3.6-13.7), 30.1 years (Q1-Q3: 24.4-37.0) at the baseline echocardiography evaluation (Echo 1), and 36.6 years (Q1-Q3: 30.8-43.6) at the last follow-up echocardiography evaluation (1,435 survivors) (Echo 2). The proportion of diastolic dysfunction was 15.2% (95% CI: 14.0%-16.4%) at Echo 1 and 15.7% (95% CI: 13.9%-17.7%) at Echo 2, largely attributable to concurrent systolic dysfunction. Less than 5% of survivors with preserved ejection fraction had diastolic dysfunction (2.2% at Echo 1, 3.7% at Echo 2). Using global longitudinal strain assessment in adult survivors with preserved ejection fraction (defined with a cut point worse than −15.9%), the proportion of diastolic dysfunction increased to 9.2% at baseline and 9.0% at follow-up. Conclusions The prevalence of isolated diastolic dysfunction is low among adults who received cardiotoxic therapies for childhood cancer. The inclusion of left ventricular global longitudinal strain significantly increased the identification of diastolic dysfunction.When using downloaded data, please cite corresponding paper. 1. Palmer C, Mazur W, Truong V, et al. Prevalence of Diastolic Dysfunction in Adult Survivors of Childhood Cancer. J Am Coll Cardiol CardioOnc. null2023, 0 (0) .https://doi.org/10.1016/j.jaccao.2022.12.010 FUNDING SUPPORT AND AUTHOR DISCLOSURES Support to St. Jude Children's Research Hospital was provided by National Cancer Institute grant U01 CA195547 (Drs Ness and principal investigators]), the Cancer Center Support grant P30CA21765 (Dr Roberts [principal investigator), and the American Lebanese-Syrian Associated Charities. The authors have reported that they have no relationships relevant to the contents of this paper to disclose