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3057715 
Journal Article 
Diffuse myocardial fibrosis by T-1-mapping in children with subclinical anthracycline cardiotoxicity: relationship to exercise capacity, cumulative dose and remodeling 
Tham, EB; Haykowsky, MJ; Chow, K; Spavor, M; Kaneko, S; Khoo, NeeS; Pagano, JJ; Mackie, AS; Thompson, RB 
2013 
Yes 
Journal of Cardiovascular Magnetic Resonance
ISSN: 1097-6647
EISSN: 1532-429X 
15 
23758789 
WOS:000320671100001 
Background: The late cardiotoxic effects of anthracycline chemotherapy influence morbidity and mortality in the growing population of childhood cancer survivors. Even with lower anthracycline doses, evidence of adverse cardiac remodeling and reduced exercise capacity exist. We aim to examine the relationship between cardiac structure, function and cardiovascular magnetic resonance (CMR) tissue characteristics with chemotherapy dose and exercise capacity in childhood cancer survivors. Methods: Thirty patients (15 +/- 3 years), at least 2 years following anthracycline treatment, underwent CMR, echocardiography, and cardiopulmonary exercise testing (peak VO2). CMR measured ventricular function, mass, T-1 and T-2 values, and myocardial extracellular volume fraction, ECV, a measure of diffuse fibrosis based on changes in myocardial T-1 values pre- and post-gadolinium. Cardiac function was also assessed with conventional and speckle tracking echocardiography. Results: Patients had normal LVEF (59 +/- 7%) but peak VO2 was 17% lower than age-predicted normal values and were correlated with anthracycline dose (r = -0.49). Increased ECV correlated with decreased mass/volume ratio (r = -0.64), decreased LV wall thickness/height ratio (r = -0.72), lower peak VO2(r = -0.52), and higher cumulative dose (r = 0.40). Echocardiographic measures of systolic and diastolic function were reduced compared to normal values (p < 0.01), but had no relation to ECV, peak VO2 or cumulative dose. Conclusions: Myocardial T-1 and ECV were found to be early tissue markers of ventricular remodeling that may represent diffuse fibrosis in children with normal ejection fraction post anthracycline therapy, and are related to cumulative dose, exercise capacity and myocardial wall thinning. 
CT; CMR; T1 mapping; Echocardiography; Contractile function; Cardiovascular imaging agents/Techniques; Exercise testing; Cardiac function; Cardiovascular magnetic resonance; Myocardial fibrosis; Speckle tracking echocardiography; T1 mapping