Ventricular Arterial Coupling as a Marker of Early Cardiotoxicity in Survivors of Childhood Cancer.

Improved childhood cancer survival has been accompanied by substantial late morbidity and mortality related to cardiotoxic cancer therapies. We conducted a retrospective study of childhood cancer survivors (CCS) diagnosed before age 21 and followed at The Children's Hospital at Montefiore (CHAM). Collected data included demographics, cancer diagnosis and treatment details, medical history, and ambulation status. Initial and most recent echocardiograms obtained at CHAM were reviewed to calculate arterial elastance (Ea), end-systolic elastance (Ees), and ventricular-arterial coupling (VAC). Measurements were compared between CCS and healthy controls and between high- and low-risk CCS for cardiotoxicity using chi-square and Mann-Whitney tests, as appropriate. Multivariable regression assessed predictors of VAC. Sixty-nine CCS were included (median age at diagnosis 7.1 years, IQR 2.9-12.1). All participants had a left ventricular ejection fraction (LVEF) > 55% at follow-up. Compared with controls, CCS demonstrated significantly lower LVEF & LV mass (p < 0.05). Although both Ea and Ees were lower in CCS, VAC ratios did not differ between CCS and controls. High-risk CCS had significantly lower Ees and VAC ratios (p < 0.05). In multivariable analysis, cumulative anthracycline dose was independently associated with VAC ratio. Receiver operating characteristic (ROC) analyses demonstrated that VAC performed comparably to LVEF in identifying patients at high risk for cardiotoxicity. VAC serves as a complementary echocardiographic biomarker in CCS, particularly for those at increased cardiotoxic risk, and may offer mechanistic insights into heart failure development in this population.