圣裘德终生队列研究中儿童癌症成年幸存者的自主神经功能障碍

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology Pub Date : 2024-10-01 DOI:10.1016/j.jaccao.2024.08.005

John D. Groarke MBBCh, MPH , Kirsten K. Ness PT, PhD , Rikeenkumar Dhaduk , Juan C. Plana MD , Jean Bernard Durand MD , Russell V. Luepker MD, MS , Vijaya M. Joshi MD , Matthew Ehrhardt MD , Daniel A. Mulrooney MD , Stephanie B. Dixon MD , Anju Nohria MD , Daniel M. Green MD , Rebecca M. Howell PhD , Deo Kumar Srivastava PhD , John L. Jefferies MD, MPH , Leslie L. Robison PhD , Melissa M. Hudson MD , Gregory T. Armstrong MD, MSCE

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引用次数: 0

摘要

背景儿童癌症幸存者自主神经功能障碍的负担和功能意义尚不清楚。目的我们评估了幸存者自主神经功能障碍的患病率、风险因素和功能意义。方法我们对 1,041 名接受过蒽环类药物治疗（31.1%）、胸部放射治疗（13.5%）、两种治疗均接受（19.5%）或两种治疗均未接受（35.9%）的儿童癌症成年幸存者，以及加入 SJLIFE（圣裘德终生队列研究）的 286 名社区对照受试者进行了横断面前瞻性评估。研究人员评估了自律神经功能失调的四项指标：静息心率升高、心率储备下降、收缩压对运动的反应减弱以及心率恢复延迟。结果幸存者（50.7% 为女性）确诊癌症时的年龄为 9.0 ± 5.8 岁，评估时的年龄为 35.5 ± 8.9 岁。幸存者与对照组相比，静息心率升高（17.9% 对 7.0%）、心率储备降低（21.7% 对 9.1%）、收缩压对运动的反应降低（25.3% 对 12.6%）和心率恢复延迟（24.3% 对 10.6%）的发生率高出 2 倍多（P 均为 0.001）。卡铂（调整后 OR：2.50；95% CI：1.42-4.40；P = 0.001）、胸部定向放疗（调整后 OR：2.06；95% CI：1.52-2.75；P <；0.001）和颅脑放疗（调整后 OR：1.49；95% CI：1.08-2.05；P = 0.015）与自主神经功能障碍≥2 项指标的可能性增加有关。结论儿童癌症幸存者出现与心肺功能受损相关的自主神经功能障碍的几率较高。

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Autonomic Dysfunction Among Adult Survivors of Childhood Cancer in the St. Jude Lifetime Cohort Study

Background

The burden and functional significance of autonomic dysfunction among survivors of childhood cancer is unknown.

Objectives

We evaluated the prevalence, risk factors, and functional relevance of autonomic dysfunction in survivors.

Methods

We conducted a cross-sectional prospective evaluation of 1,041 adult survivors of childhood cancer treated with anthracyclines (31.1%), chest-directed radiation (13.5%), both (19.5%), or neither (35.9%), and 286 community control subjects enrolled in the SJLIFE (St Jude Lifetime Cohort Study). Four measures of autonomic dysfunction were evaluated: elevated resting heart rate, decreased heart rate reserve, decreased systolic blood pressure response to exercise, and delayed heart rate recovery. Logistic regression tested associations with impaired cardiorespiratory fitness (peak Vo₂ < 80% predicted).

Results

Survivors (50.7% female) were 9.0 ± 5.8 years at cancer diagnosis and 35.5 ± 8.9 years at evaluation. Prevalence (survivors vs control subjects) of elevated resting heart rate (17.9% vs 7.0%), decreased heart rate reserve (21.7% vs 9.1%), decreased systolic blood pressure response to exercise (25.3% vs 12.6%), and delayed heart rate recovery (24.3% vs 10.6%) was more than 2-fold higher among survivors (P < 0.001 for all). Carboplatin (adjusted OR: 2.50; 95% CI: 1.42-4.40; P = 0.001), chest-directed radiation therapy (adjusted OR: 2.06; 95% CI: 1.52-2.75; P < 0.001), and cranial radiation (adjusted OR: 1.49; 95% CI: 1.08-2.05; P = 0.015) were associated with an increased likelihood of having ≥2 measures of autonomic dysfunction. Survivors with ≥2 measures of autonomic dysfunction were at increased risk for impaired cardiorespiratory fitness (adjusted OR: 2.71; 95% CI: 1.82-4.02; P < 0.001).

Conclusions

Survivors of childhood cancer manifest a higher prevalence of autonomic dysfunction associated with impaired cardiorespiratory fitness.

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来源期刊

Jacc: Cardiooncology Multiple-

CiteScore

12.50

自引率

6.30%

发文量

106

期刊介绍： JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.