Heart and Circulation

Aim: Using conventional and novel cardiac magnetic resonance (CMR) techniques, we examined cardiac function in a cohort of late cancer survivors, previously studied with echocardiography in childhood. We compared to healthy controls, to characterize current state in the context of longitudinal functional data. Methods: 30 patients treated with anthracyclines in childhood and 19 matched controls underwent echocardiography and CMR. Additionally, CMR myocardial T1 maps were obtained using a Modified Look-Locker Inversion Recovery (MOLLI) sequence, and CMR tissue phase mapping (TPM) was performed using a rotating golden-angle spiral acquisition. Results: Patients were a median (range) age 33 (25-43) years, and were studied 27(16-33) years following a cumulative anthracycline dose of 220 (90-370) mg/m2. Mean extracellular volume fraction (ECV) in patients was 0.26 ± 0.04, and was higher in patients receiving cumulative doses of >300mg/m2 (0.25 ± 0.02 vs. 0.28 ± 0.05, p=0.02). Native myocardial T1 was similar between patients and controls (967 ± 37 vs. 960 ± 37, p=0.53). TPM-derived LV radial and longitudinal systolic velocities, and longitudinal E:A ratio were not significantly reduced. Current CMR-derived LV ejection fraction was normal, although reduced compared to controls (61% ± 6 vs. 65% ± 5, p<0.01). This correlated negatively with cumulative anthracycline dose (R2 0.26, p<0.01) and positively with historic echo fractional shortening (R2 0.27, p <0.03). Conclusion: This detailed CMR assessment of a cohort of survivors, 25 years following childhood anthracycline chemotherapy, showed persistent impairment, but often sub-clinical and dosedependent. Novel CMR myocardial characterization and motion analysis found no differences compared to controls, but with greater numbers, these techniques may provide insight into long-term features of myocardial damage and remodeling.