Development and phenotype of heart failure in long-term survivors of childhood cancer : the CVSS study

Abstract

BACKGROUND: The CVSS (Cardiac and Vascular Late Sequelae in Long-Term Survivors of Childhood Cancer) study aimed to investigate the prevalence of different stages of heart failure (HF) in childhood cancer survivors (CCSs) compared with the general population. METHODS AND RESULTS: A total of 1002 CCSs (age range, 23–48years) diagnosed with neoplasia before an age of 15years underwent a comprehensive cardiovascular screening. An age- and sex-matched sample from the population-based GHS (Gutenberg Health Study) served as a comparison group. Although prevalence of HF was significantly higher in CCSs, preva lence of different HF stages varied strongly by specific tumor history. Compared with the population, the prevalence ratio was 2.6 (95% CI, 2.4–2.8) for HF stage A and 4.6 (95% CI, 4.1–5.1) for the composite of HF stage B to D in an age- and sex adjusted Poisson regression model. Multivariable linear regression, adjusting for tumor entities, age, sex, and cardiovascular risk factors, revealed a lower left ventricular ejection fraction in patients with history of bone tumors (β, −4.30 [95% CI, −5.70 to −2.80]), soft tissue sarcoma (β, −1.60 [95% CI, −2.90 to −0.30]), and renal tumors (β, −1.60 [95% CI, −2.80 to −0.29]) com pared with the population. The same model for the diastolic marker, ratio of the peak early diastolic filling velocity/lateral mitral annular early diastolic velocity, showed an association only with cardiovascular risk factors but not with tumor entities. CONCLUSIONS: The prevalence of HF stage A to D was significantly higher among long-term CCSs compared with the popula tion and varied strongly by tumor entity. Systolic dysfunction was primarily associated with tumor entities, whereas diastolic dysfunction was associated with a higher burden of cardiovascular risk factors in CCSs.