Diastolic function assessment with left atrial strain in long-term survivors of childhood acute lymphoblastic leukemia.

INTRODUCTION AND OBJECTIVES: Survivors of childhood cancer might be at increased risk of diastolic dysfunction at follow-up due to exposure to cardiotoxic treatment. Although assessment of diastolic function is challenging in this relatively young population, left atrial strain might provide a novel insight in this evaluation. Our aim was to examine diastolic function in a cohort of long-term survivors of childhood acute lymphoblastic leukemia by using left atrial strain and conventional echocardiographic parameters. METHODS: Long-term survivors who were diagnosed at a single center between 1985 and 2015 and a control group of healthy siblings were recruited. Conventional diastolic function parameters and atrial strain were compared, and the latter was measured during the 3 atrial phases: reservoir (PALS), conduit (LACS) and contraction (PACS). Inverse probability of treatment weighting was used to account for differences between the groups. RESULTS: We analyzed 90 survivors (age, 24.6±9.7 years, time since diagnosis 18 [11-26] years) and 58 controls. PALS and LACS were significantly reduced compared with the control group: 46.4±11.2 vs 52.1±11.7; P=.003 and 32.5±8.8 vs 38.2±9.3; P=.003, respectively. Conventional diastolic parameters and PACS were similar between the groups. The reductions in PALS and LACS were associated with exposure to cardiotoxic treatment in age- and sex-adjusted analysis (≥ moderate risk, low risk, controls): 45.4±10.5, 49.5±12.9, 52.1±11.7; Padj=.003, and 31.7±9.0, 35.2±7.5, 38.2±9.3; Padj=.001, respectively. CONCLUSIONS: Long-term childhood leukemia survivors showed a subtle impairment of diastolic function that was detected with atrial strain but not with conventional measurements. This impairment was more pronounced in those with higher exposure to cardiotoxic treatment.

Right Ventricular Function in Long-Term Survivors of Childhood Acute Lymphoblastic Leukemia: From the CTOXALL Study.

There are limited data regarding right ventricle (RV) impairment in long-term survivors of childhood acute lymphoblastic leukemia (CLS). The aim of this study was to assess RV function in these patients using echocardiographic conventional measurements and automated RV strain. Echocardiographic recordings of 90 CLS and 58 healthy siblings from the CTOXALL cohort were analyzed. For group comparisons, inverse probability weighting was used to reduce confounding. The CLS group (24.6 ± 9.7 years, 37.8% women) underwent an echocardiographic evaluation 18 (11-26) years after the diagnosis. RV systolic dysfunction was found in 16.7% of CLS individuals using RV free-wall strain (RVFWS) compared to 2.2 to 4.4% with conventional measurements. RV systolic function measurements were lower in the CLS than in the control group: TAPSE (23.3 ± 4.0 vs. 25.2 ± 3.4, p = 0.004) and RVFWS (24.9 ± 4.6 vs. 26.8 ± 4.7, p = 0.032). Modifiable cardiovascular risk factors such as obesity (p = 0.022) and smoking (p = 0.028) were independently associated with reduced RVFWS. In conclusion, RV systolic function impairment was frequent in long-term survivors of childhood leukemia, underscoring the importance of RV assessment, including RVFWS, in the cardiac surveillance of these patients.

Migraña y Riesgo de Enfermedad Cardiovascular / Migraine and risk of cardiovascular disease

Introducción: la migraña se presenta con más frecuencia en personas que presentan factores de riesgo cardiovascular. Objetivo: mediante esta revisión bibliográfica narrativa se busca actualizar el conocimiento acerca de la relación existente entre migraña y el riesgo de enfermedad cardiovascular para mejorar la evaluación clínica de estos pacientes. Métodos: se realizó una búsqueda bibliográfica electrónica en Pubmed, Science Direct, Cochrane, Trip Medical Database, New England Journal of Medicine, Elsevier, sobre migraña y riesgo cardiovascular para obtener información con la mejor calidad de evidencia posible. Resultados: se recopilaron 68 artículos, de los cuales se eligieron 33 que cumplieron con los criterios de inclusión y exclusión planteados. Discusión: la migraña es una cefalea primaria que afecta sobre todo a mujeres jóvenes, las personas que padecen migraña con aura presentan un incremento de riesgo de enfermedad cardiovascular ocasionado por disfunción endotelial. El riesgo global es bajo, sin embargo se hace énfasis en la relación existente entre ambos para mejorar la evaluación del riesgo cardiovascular. Conclusiones: existe una estrecha relación entre la migraña con aura y el riesgo de enfermedad cardiovascular, sobre todo en mujeres que tienen otros factores de riesgo cardiovascular. Una adecuada evaluación de dichos factores disminuiría la morbimortalidad de los individuos que padecen de migraña.