Childhood Cancer Survivors Should Include TRV As Part of Routine Screening Echocardiogram

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(ChemotherapyAdvisor) – Increased tricuspid regurgitant jet velocity (TRV) is observed in a substantial number of adult survivors of childhood cancer who received chest-directed radiation therapy (RT), “and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction,” investigators from the St. Jude Children's Research Hospital reported in the Journal of Clinical Oncology published online January 7, 2013.

“Treatment of children with cancer has become increasingly successful, with more than 80% of patients achieving 5-year survival and the majority surviving into adulthood,” noted Gregory T. Armstrong, MD, MSCE, of the Department of Epidemiology & Cancer Control at St. Jude in Memphis, TN, and colleagues.

The investigators performed a cross-sectional evaluation of 498 survivors at a median age of 38 years (range, 20-59 years) and a median of 27.3 years (range, 12.2-46.0 years) from primary cancer diagnosis to determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer.

Associations with chest-directed RT and measures of current cardiac function, lung function, and exercise capacity were also determined. “Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography,” they stated.

They identified increased TRV in 25.2% of survivors who received chest-directed RT and 30.8% of those who received more than 30 Gy.

Increased TRV was associated with increasing dose of RT (1−19.9 Gy: odds ratio [OR] 2.09; 95% CI: 0.63−6.96; 20−29.9 Gy: OR 3.46; 95% CI: 1.59−7.54; ≥30 Gy: OR 4.54; 95% CI: 1.77−11.64 compared with no RT; P for trend <0.001), body mass index >40 kg/m2 (OR 3.89; 95% CI: 1.46−10.39), and aortic valve regurgitation (OR 5.85; 95% CI: 2.05−16.74).

When compared with survivors with a TRV 2.8 m/s or higher, those with a TRV higher than 2.8 m/s had increased risk of severe functional limitation on a 6-minute walk (OR 5.20; 95% CI: 2.5−11.0).

“Evaluation of TRV should be part of the routine screening echocardiogram, although ongoing studies seek to further define the significance and natural history of an increased TRV in this population,” Dr. Armstrong concluded.


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