TY - JOUR
T1 - Diastolic Dysfunction is Common in Survivors of Pediatric Differentiated Thyroid Carcinoma
AU - Klein Hesselink, Mariëlle S.
AU - Bocca, Gianni
AU - Hummel, Yoran M.
AU - Brouwers, Adrienne H.
AU - Burgerhof, Johannes G.M.
AU - Van Dam, Eveline W.C.M.
AU - Gietema, Jourik A.
AU - Havekes, Bas
AU - Van Den Heuvel-Eibrink, Marry M.
AU - Corssmit, Eleonora P.M.
AU - Kremer, Leontien C.M.
AU - Netea-Maier, Romana T.
AU - Van Der Pal, Helena J.H.
AU - Peeters, Robin P.
AU - Plukker, John T.M.
AU - Ronckers, Cécile M.
AU - Van Santen, Hanneke M.
AU - Van Der Meer, Peter
AU - Tissing, Wim J.E.
AU - Links, Thera P.
N1 - Publisher Copyright:
© Copyright 2017, Mary Ann Liebert, Inc. 2017.
PY - 2017/12
Y1 - 2017/12
N2 - INTRODUCTION: Whether pediatric patients with differentiated thyroid carcinoma (DTC) are at risk of developing treatment-related adverse effects on cardiac function is unknown. We therefore studied in long-term survivors of pediatric DTC the prevalence of cardiac dysfunction and atrial fibrillation in relation to treatment variables, and the association between cardiac dysfunction and plasma biomarkers.METHODS: In this nationwide prospective multicenter study, cardiac assessments were performed in 66 adult survivors of pediatric DTC (age at diagnosis ≤18 years and follow-up ≥5 years after diagnosis) treated in the Netherlands between 1970 and 2009. Assessment included echocardiography, plasma biomarkers (N-terminal pro-brain natriuretic peptide, high-sensitive troponin-T, galectin-3), and 24-hour Holter electrocardiography. Echocardiographic measurements were compared with retrospective data of 66 sex- and age-matched unaffected Dutch controls. Diastolic dysfunction was defined as an early diastolic septal and/or lateral tissue velocity (e') less than 2 SD of mean age-adjusted reference data.RESULTS: The survivors (86.4% women) had at DTC diagnosis a median age of 16 years. Median follow-up was 17 years. Left ventricular ejection fraction <50% was found in one survivor, and median global longitudinal systolic strain was near normal. Diastolic dysfunction was present in 14 asymptomatic survivors (21.2%). Overall, diastolic function of survivors was lower compared with controls (e'mean 14.5 versus 15.8 cm/s, P = 0.006). Older attained age and higher waist circumference were associated with decreased diastolic function, whereas thyrotropin levels and cumulative administered radioiodine dose were not. In survivors, biomarkers were not associated with diastolic dysfunction; atrial fibrillation was not observed.CONCLUSION: While systolic function is unaffected, diastolic dysfunction is frequently observed in asymptomatic long-term survivors of pediatric DTC, which may suggest early cardiac aging.
AB - INTRODUCTION: Whether pediatric patients with differentiated thyroid carcinoma (DTC) are at risk of developing treatment-related adverse effects on cardiac function is unknown. We therefore studied in long-term survivors of pediatric DTC the prevalence of cardiac dysfunction and atrial fibrillation in relation to treatment variables, and the association between cardiac dysfunction and plasma biomarkers.METHODS: In this nationwide prospective multicenter study, cardiac assessments were performed in 66 adult survivors of pediatric DTC (age at diagnosis ≤18 years and follow-up ≥5 years after diagnosis) treated in the Netherlands between 1970 and 2009. Assessment included echocardiography, plasma biomarkers (N-terminal pro-brain natriuretic peptide, high-sensitive troponin-T, galectin-3), and 24-hour Holter electrocardiography. Echocardiographic measurements were compared with retrospective data of 66 sex- and age-matched unaffected Dutch controls. Diastolic dysfunction was defined as an early diastolic septal and/or lateral tissue velocity (e') less than 2 SD of mean age-adjusted reference data.RESULTS: The survivors (86.4% women) had at DTC diagnosis a median age of 16 years. Median follow-up was 17 years. Left ventricular ejection fraction <50% was found in one survivor, and median global longitudinal systolic strain was near normal. Diastolic dysfunction was present in 14 asymptomatic survivors (21.2%). Overall, diastolic function of survivors was lower compared with controls (e'mean 14.5 versus 15.8 cm/s, P = 0.006). Older attained age and higher waist circumference were associated with decreased diastolic function, whereas thyrotropin levels and cumulative administered radioiodine dose were not. In survivors, biomarkers were not associated with diastolic dysfunction; atrial fibrillation was not observed.CONCLUSION: While systolic function is unaffected, diastolic dysfunction is frequently observed in asymptomatic long-term survivors of pediatric DTC, which may suggest early cardiac aging.
KW - cancer survivors
KW - diastolic dysfunction
KW - differentiated thyroid carcinoma
KW - late effects
KW - pediatric patients
UR - http://www.scopus.com/inward/record.url?scp=85038447859&partnerID=8YFLogxK
U2 - 10.1089/thy.2017.0383
DO - 10.1089/thy.2017.0383
M3 - Article
C2 - 29132262
SN - 1050-7256
VL - 27
SP - 1481
EP - 1489
JO - Thyroid : official journal of the American Thyroid Association
JF - Thyroid : official journal of the American Thyroid Association
IS - 12
ER -