d Original Contribution MYOCARDIAL STRAIN AND STRAIN RATE IN MONITORING SUBCLINICAL HEART FAILURE INASYMPTOMATIC LONG-TERM SURVIVORS OF CHILDHOOD CANCER ANNELIES M. C. MAVINKURVE-GROOTHUIS,* J ACQUELINE GROOT -LOONEN,* KAREN A. MARCUS, y LOUISE BELLERSEN, z TON FEUTH, x JOS P. M. BO ¨ KKERINK,* PETER M. HOOGERBRUGGE,* CHRIS DE KORTE, k and LIVIA KAPUSTA y{ *Department of Pediatric Hematology and Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; y Children’s Heart Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; z Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; x Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; k Clinical Physics Laboratory, Department of Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; and { Heart Institute, Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel (Received 26 February 2010; revised 29 June 2010; in final form 7 August 2010) Abstract—We studied the role of global myocardial strain and strain rate in monitoring subclinical heart failure in a large group of asymptomatic long-term survivors of childhood cancer. Global strain (rate) parameters of survi- vors were compared with those in healthy controls and were related to conventional echocardiographic parameters, N-terminal-pro-natriuretic peptide (NT-pro-BNP) levels and clinical parameters. Two-dimensional (2-D) echocar- diography was performed in 111 survivors and 107 healthy controls. Blood samples were taken from survivors to determine NT-pro-BNP levels. We showed that global myocardial strain, strain rate and time to peak systolic strain in asymptomatic survivors of childhood cancer were significantly lower compared with healthy controls (p values ,0.0001) and were significantly related to several systolic and diastolic left ventricular parameters. Whether myocardial strain and strain rate are superior to conventional echocardiography in the early detection of subclin- ical heart failure needs to be explored in further longitudinal prospective studies. (E-mail: A.Mavinkurve@cukz. umcn.nl) Ó 2010 World Federation for Ultrasound in Medicine & Biology. Key Words: Myocardial strain, 2-D echocardiography, Anthracycline-induced cardiotoxicity, Late-onset cardiotoxicity, Childhood cancer. INTRODUCTION Late onset anthracycline-induced cardiotoxicity is a well- known late effect of treatment of childhood cancer. Subclinical heart failure occurs in up to 65% of asymptom- atic survivors of childhood cancer (Wouters et al. 2005). Newer techniques, such as myocardial strain imaging and biomarkers still have to prove their prognostic value in the early detection of anthracycline-induced cardiotox- icity (Marwick 2006; Gianni et al. 2008). Myocardial strain imaging with two-dimensional (2-D) echocardiography is a relatively new noninvasive method to assess myocardial deformation (Reisner et al. 2004). Strain is the change in size relative to its original size, i.e., the relative deformation. Myocardial strain imaging is now increasingly used in clinical studies (Leitman et al. 2004; Korinek et al. 2005; Jurcut et al. 2008; Ng et al. 2009; Nesbitt et al. 2009). Recently, we showed that in a group of asymptomatic survivors of childhood cancer, myocardial strain imaging with 2-D echocardiography can produce scores with high interobserver, intraobserver and intrapatient reliability (Mavinkurve-Groothuis et al. 2009a). Two studies so far have demonstrated that myocardial longitudinal strain and strain rate are decreased directly after anthracycline therapy for childhood malignancies and in asymptomatic survivors of childhood cancer (Ganame et al. 2007a; 2007b). Two studies in adults showed reduction in myocardial strain and strain rate directly Address correspondence to: A.M.C. Mavinkurve-Groothuis, Department of Pediatric Hematology and Oncology, P.O. Box 9101, huispost 804, 6500 HB Nijmegen, The Netherlands. E-mail: A.Mavinkurve@cukz.umcn.nl 1783 Ultrasound in Med. & Biol., Vol. 36, No. 11, pp. 1783–1791, 2010 Copyright Ó 2010 World Federation for Ultrasound in Medicine & Biology Printed in the USA. All rights reserved 0301-5629/$ - see front matter doi:10.1016/j.ultrasmedbio.2010.08.001