Right ventricular function among adult survivors of childhood cancer

Background : Cardiotoxic effects of childhood cancer treatment on the right ventricle (RV) are sparsely studied among long-term childhood cancer survivors (CCS). Objectives : We investigated RV function and risk factors for impaired function. Methods : We invited CCS ≥18 years of age, diagnosed between ages 0–20 years, treated in one of five pediatric oncology centers across Switzerland from 1976–2017, who survived ≥5 years, for an echocardiographic assessment of the RV including tricuspid annular plane systolic excursion (TAPSE, abnormal <17mm) and Doppler tissue imaging (DTI, abnormal <9.5cm/s). Results : We included 432 CCS with median age at study of 34 years (interquartile range 26–40). Overall prevalence of RV dysfunction was 4% for both methods (mean TAPSE 22.5±3.8mm; mean DTI 13.1±2.2cm/s). Risk factors for decreased RV function were cumulative heart-relevant radiotherapy (RT) dose [Beta coefficient (B)=-0.46;95%CI -0.73– -0.20]; hematopoietic stem cell transplantation (B=-1.88;95%CI -3.35– -0.40); cisplatin (B=-1.29;95%CI -2.38– -0.19); diabetes mellitus (B=-2.57;95%CI -4.99– -0.15); and abdominal obesity (B=-0.79;95%CI -1.58–0.00) when measured by TAPSE. For DTI, we identified cumulative heart-relevant RT dose (B=-0.19; 95%CI -0.37– -0.01); relapse (B=-0.94;95%CI -1.74– -0.15); and abdominal obesity (B=-0.80;95%CI -1.37– -0.24) as risk factors. Cumulative anthracycline dose was not associated with impaired RV function measured by TAPSE (B=-0.23;95%CI -0.49–0.03) or DTI (B=-0.06;95%CI -0.25–0.13). Conclusions : RV dysfunction is rare in young adult CCS. The risk is increased after heart-relevant RT and by obesity. Given the prognostic value of RV dysfunction for all-cause mortality, we suggest including RV echocardiography to the routine follow-up care of CCS.