Increased tricuspid regurgitant jet velocity by doppler echocardiography in adult survivors of childhood cancer

A report from the st jude lifetime cohort study

Gregory Armstrong, Vijaya M. Joshi, Liang Zhu, Deokumar Srivastava, Nan Zhang, Kirsten K. Ness, Dennis C. Stokes, Matthew T. Krasin, James A. Fowler, Leslie L. Robison, Melissa M. Hudson, Daniel M. Green

Research output: Contribution to journalArticle

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Abstract

Purpose To determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer, and associations with chest-directed radiation therapy (RT) and measures of current cardiac function, lung function, and exercise capacity. Patients and Methods Cross-sectional evaluation of 498 survivors at a median age of 38.0 years (range, 20.0 to 59.0 years) and a median of 27.3 years (range, 12.2 to 46.0 years) from primary cancer diagnosis was performed. Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography. Results Increased TRV was identified in 25.2% of survivors who received chest-directed RT and 30.8% of those who received more than 30 Gy. In multivariable models, increased TRV was associated with increasing dose of RT (1 to 19.9 Gy: odds ratio [OR], 2.09; 95% CI, 0.63 to 6.96; 20 to 29.9 Gy: OR, 3.46; 95% CI, 1.59 to 7.54; ≤ 30 Gy: OR, 4.54; 95% CI, 1.77 to 11.64 compared with no RT; P for trend < .001), body mass index more than 40 kg/m2 (OR, 3.89; 95% CI, 1.46 to 10.39), and aortic valve regurgitation (OR, 5.85; 95% CI, 2.05 to 16.74). Survivors with a TRV more than 2.8 m/s had increased odds (OR, 5.20; 95% CI, 2.5 to 11.0) of severe functional limitation on a 6-minute walk compared with survivors with a TRV ≤ 2.8 m/s. Conclusion A substantial number of adult survivors of childhood cancer who received chest-directed RT have an increased TRV and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction. Longitudinal follow-up and confirmation by cardiac catheterization are warranted.

Original languageEnglish (US)
Pages (from-to)774-781
Number of pages8
JournalJournal of Clinical Oncology
Volume31
Issue number6
DOIs
StatePublished - Feb 20 2013

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Doppler Echocardiography
Survivors
Cohort Studies
Odds Ratio
Radiotherapy
Neoplasms
Thorax
Pulmonary Hypertension
Aortic Valve Insufficiency
Lung Injury
Cardiac Catheterization
Body Mass Index
Exercise
Lung

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Increased tricuspid regurgitant jet velocity by doppler echocardiography in adult survivors of childhood cancer : A report from the st jude lifetime cohort study. / Armstrong, Gregory; Joshi, Vijaya M.; Zhu, Liang; Srivastava, Deokumar; Zhang, Nan; Ness, Kirsten K.; Stokes, Dennis C.; Krasin, Matthew T.; Fowler, James A.; Robison, Leslie L.; Hudson, Melissa M.; Green, Daniel M.

In: Journal of Clinical Oncology, Vol. 31, No. 6, 20.02.2013, p. 774-781.

Research output: Contribution to journalArticle

Armstrong, G, Joshi, VM, Zhu, L, Srivastava, D, Zhang, N, Ness, KK, Stokes, DC, Krasin, MT, Fowler, JA, Robison, LL, Hudson, MM & Green, DM 2013, 'Increased tricuspid regurgitant jet velocity by doppler echocardiography in adult survivors of childhood cancer: A report from the st jude lifetime cohort study', Journal of Clinical Oncology, vol. 31, no. 6, pp. 774-781. https://doi.org/10.1200/JCO.2012.43.0702
Armstrong, Gregory ; Joshi, Vijaya M. ; Zhu, Liang ; Srivastava, Deokumar ; Zhang, Nan ; Ness, Kirsten K. ; Stokes, Dennis C. ; Krasin, Matthew T. ; Fowler, James A. ; Robison, Leslie L. ; Hudson, Melissa M. ; Green, Daniel M. / Increased tricuspid regurgitant jet velocity by doppler echocardiography in adult survivors of childhood cancer : A report from the st jude lifetime cohort study. In: Journal of Clinical Oncology. 2013 ; Vol. 31, No. 6. pp. 774-781.
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title = "Increased tricuspid regurgitant jet velocity by doppler echocardiography in adult survivors of childhood cancer: A report from the st jude lifetime cohort study",
abstract = "Purpose To determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer, and associations with chest-directed radiation therapy (RT) and measures of current cardiac function, lung function, and exercise capacity. Patients and Methods Cross-sectional evaluation of 498 survivors at a median age of 38.0 years (range, 20.0 to 59.0 years) and a median of 27.3 years (range, 12.2 to 46.0 years) from primary cancer diagnosis was performed. Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography. Results Increased TRV was identified in 25.2{\%} of survivors who received chest-directed RT and 30.8{\%} of those who received more than 30 Gy. In multivariable models, increased TRV was associated with increasing dose of RT (1 to 19.9 Gy: odds ratio [OR], 2.09; 95{\%} CI, 0.63 to 6.96; 20 to 29.9 Gy: OR, 3.46; 95{\%} CI, 1.59 to 7.54; ≤ 30 Gy: OR, 4.54; 95{\%} CI, 1.77 to 11.64 compared with no RT; P for trend < .001), body mass index more than 40 kg/m2 (OR, 3.89; 95{\%} CI, 1.46 to 10.39), and aortic valve regurgitation (OR, 5.85; 95{\%} CI, 2.05 to 16.74). Survivors with a TRV more than 2.8 m/s had increased odds (OR, 5.20; 95{\%} CI, 2.5 to 11.0) of severe functional limitation on a 6-minute walk compared with survivors with a TRV ≤ 2.8 m/s. Conclusion A substantial number of adult survivors of childhood cancer who received chest-directed RT have an increased TRV and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction. Longitudinal follow-up and confirmation by cardiac catheterization are warranted.",
author = "Gregory Armstrong and Joshi, {Vijaya M.} and Liang Zhu and Deokumar Srivastava and Nan Zhang and Ness, {Kirsten K.} and Stokes, {Dennis C.} and Krasin, {Matthew T.} and Fowler, {James A.} and Robison, {Leslie L.} and Hudson, {Melissa M.} and Green, {Daniel M.}",
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T1 - Increased tricuspid regurgitant jet velocity by doppler echocardiography in adult survivors of childhood cancer

T2 - A report from the st jude lifetime cohort study

AU - Armstrong, Gregory

AU - Joshi, Vijaya M.

AU - Zhu, Liang

AU - Srivastava, Deokumar

AU - Zhang, Nan

AU - Ness, Kirsten K.

AU - Stokes, Dennis C.

AU - Krasin, Matthew T.

AU - Fowler, James A.

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

AU - Green, Daniel M.

PY - 2013/2/20

Y1 - 2013/2/20

N2 - Purpose To determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer, and associations with chest-directed radiation therapy (RT) and measures of current cardiac function, lung function, and exercise capacity. Patients and Methods Cross-sectional evaluation of 498 survivors at a median age of 38.0 years (range, 20.0 to 59.0 years) and a median of 27.3 years (range, 12.2 to 46.0 years) from primary cancer diagnosis was performed. Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography. Results Increased TRV was identified in 25.2% of survivors who received chest-directed RT and 30.8% of those who received more than 30 Gy. In multivariable models, increased TRV was associated with increasing dose of RT (1 to 19.9 Gy: odds ratio [OR], 2.09; 95% CI, 0.63 to 6.96; 20 to 29.9 Gy: OR, 3.46; 95% CI, 1.59 to 7.54; ≤ 30 Gy: OR, 4.54; 95% CI, 1.77 to 11.64 compared with no RT; P for trend < .001), body mass index more than 40 kg/m2 (OR, 3.89; 95% CI, 1.46 to 10.39), and aortic valve regurgitation (OR, 5.85; 95% CI, 2.05 to 16.74). Survivors with a TRV more than 2.8 m/s had increased odds (OR, 5.20; 95% CI, 2.5 to 11.0) of severe functional limitation on a 6-minute walk compared with survivors with a TRV ≤ 2.8 m/s. Conclusion A substantial number of adult survivors of childhood cancer who received chest-directed RT have an increased TRV and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction. Longitudinal follow-up and confirmation by cardiac catheterization are warranted.

AB - Purpose To determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer, and associations with chest-directed radiation therapy (RT) and measures of current cardiac function, lung function, and exercise capacity. Patients and Methods Cross-sectional evaluation of 498 survivors at a median age of 38.0 years (range, 20.0 to 59.0 years) and a median of 27.3 years (range, 12.2 to 46.0 years) from primary cancer diagnosis was performed. Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography. Results Increased TRV was identified in 25.2% of survivors who received chest-directed RT and 30.8% of those who received more than 30 Gy. In multivariable models, increased TRV was associated with increasing dose of RT (1 to 19.9 Gy: odds ratio [OR], 2.09; 95% CI, 0.63 to 6.96; 20 to 29.9 Gy: OR, 3.46; 95% CI, 1.59 to 7.54; ≤ 30 Gy: OR, 4.54; 95% CI, 1.77 to 11.64 compared with no RT; P for trend < .001), body mass index more than 40 kg/m2 (OR, 3.89; 95% CI, 1.46 to 10.39), and aortic valve regurgitation (OR, 5.85; 95% CI, 2.05 to 16.74). Survivors with a TRV more than 2.8 m/s had increased odds (OR, 5.20; 95% CI, 2.5 to 11.0) of severe functional limitation on a 6-minute walk compared with survivors with a TRV ≤ 2.8 m/s. Conclusion A substantial number of adult survivors of childhood cancer who received chest-directed RT have an increased TRV and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction. Longitudinal follow-up and confirmation by cardiac catheterization are warranted.

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