Effect of anthracycline therapy on myocardial function and markers of fibrotic remodelling in childhood cancer survivors

Wadi Mawad, Luc Mertens, Joseph J. Pagano, Eugenie Riesenkampff, Marjolein J.E. Reichert, Seema Mital, Paul F. Kantor, Mark Greenberg, Peter Liu, Paul C. Nathan, Lars Grosse-Wortmann

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Aims: Anthracyclines are a cornerstone of paediatric cancer treatment. We aimed to quantify myocardial cardiac magnetic resonance (CMR) native T1 (NT1) and extracellular volume fraction (ECV) as markers of fibrosis in a cohort of childhood cancer survivors (CCS). Methods and results: A cohort of CCS in remission underwent CMR T1 mapping. Diastolic function was assessed by echocardiography. Results were compared to a cohort of normal controls of similar age and gender. Fifty-five CCS and 46 controls were included. Both groups had similar mean left ventricular (LV) NT1 values (999 ± 36 vs. 1007 ± 32 ms, P = 0.27); ECV was higher (25.6 ± 6.9 vs. 20.7 ± 2.4%, P = 0.003) and intracellular mass was lower (37.5 ± 8.4 vs. 43.3 ± 9.9g/m2, P = 0.02) in CCS. The CCS group had lower LV ejection fraction (EF) and LV mass index with otherwise normal diastolic function in all but one patient. The proportion of subjects with elevated ECV compared to controls did not differ between subgroups with normal or reduced LV EF (22% vs. 28%; P = 0.13) and no correlations were found between LVEF and ECV. While average values remained within normal range, mitral E/E′ (6.6 ± 1.6 vs. 5.9 ± 0.9, P = 0.02) was higher in CCS. Neither NT1 nor ECV correlated with diastolic function indices or cumulative anthracycline dose. Conclusions: There is evidence for mild diffuse extracellular volume expansion in some asymptomatic CCS; myocyte loss could be part of the mechanism, accompanied by subtle changes in systolic and diastolic function. These findings suggest mild myocardial damage and remodelling after anthracycline treatment in some CCS which requires continued monitoring.

Original languageEnglish (US)
Pages (from-to)435-442
Number of pages8
JournalEuropean heart journal cardiovascular Imaging
Issue number4
StatePublished - Apr 1 2021


  • T1 mapping
  • anthracycline cardiotoxicity
  • cardiac function
  • cardiovascular magnetic resonance
  • myocardial fibrosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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