Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 2, February, p. 243–249

doi: 10.17219/acem/115082

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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CIMT does not identify early vascular changes in childhood acute lymphoblastic leukemia survivors

Tomasz Ociepa1,A,B,C,D,E,F, Wioletta Posio2,B, Marcin Sawicki2,B, Tomasz Urasiński1,A,D,E,F

1 Department of Pediatrics, Hemato-Oncology and Gastroenterology, Pomeranian Medical University, Szczecin, Poland

2 Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, Szczecin, Poland

Abstract

Background. Childhood acute lymphoblastic leukemia (ALL) survivors are at an increased risk of cardiovascular disease development. It is believed that in the general population, this risk can be predicted with carotid intima-media thickness (CIMT) measurement.
Objectives. The objective of this study was to assess CIMT and to investigate the effects of blood pressure (BP) and lipid profile values on CIMT in childhood ALL survivors.
Material and Methods. The study group comprised 81 childhood ALL survivors aged 5–25 years. The control group consisted of 52 ageand sex-comparable healthy children. Carotid intima-media thickness measurement, 24-hour BP monitoring and lipid profiles were evaluated in patients and controls.
Results. Despite significantly higher proportion of subjects with arterial hypertension (AH) (30/81 vs 10/52; p = 0.0315), the mean values of CIMT were not statistically different in childhood ALL survivors as compared to controls (0.4303 ±0.03 vs 0.4291 ±0.03; p = 0.81 and 1.096 ±0.74 vs 1.027 ±0.55; p = 0.56, respectively). Carotid intima-media thickness values were not statistically higher in ALL survivors with AH as compared to ALL survivors with normal BP (0.433 ±0.03 vs 0.428 ±0.03; p = 0.82). A significant positive correlation between 24-hour systolic BP standard deviation score (SDS) and CIMT-SDS in childhood ALL survivors was found (r = 0.29, p = 0.009), whereas such correlation was not observed in healthy controls (r = 0.12, p = 0.39). A significant correlation between z-score body mass index (BMI) and CIMT was found in controls (r = 0.29, p = 0.031) but not in childhood ALL survivors (r = −0.05, p = 0.64). No significant correlations between CIMT and other measured variables were found. Carotid intima-media thickness did not significantly correlate with time since ALL diagnosis (r = 0.09, p = 0.39).
Conclusion. Carotid intima-media thickness measurement shows limited feasibility and diagnostic accuracy for early assessment of vascular alteration in childhood ALL survivors. Other tests are needed to predict cardiovascular risk in childhood ALL survivors at the early stage of the follow-up.

Key words

children, cardiovascular risk, arterial hypertension, acute lymphoblastic leukemia, carotid intima-media thickness

References (36)

  1. Urbina EM, Williams RV, Alpert BS, et al. American Heart Association Atherosclerosis, Hypertension, and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Noninvasive assessment of subclinical atherosclerosis in children and adolescents: Recommendations for standard assessment for clinical research. A scientific statement from the American Heart Association. Hypertension. 2009;54(5):919–950.
  2. Civilibal M, Duru NS, Elevli M. Subclinical atherosclerosis and ambulatory blood pressure in children with metabolic syndrome. Pediatr Nephrol. 2014;29(11):2197–2204.
  3. Rodrigues TM, Barra CB, Santos JL, Goulart EM, Ferreira AV, Silva IN. Cardiovascular risk factors and increased carotid intima-media thickness in young patients with congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Arch Endocrinol Metab. 2015;59(5):541–547.
  4. Rostampour N, Fekri K, Hashemi-Dehkordi E, Obodiat M. Association between vascular endothelial markers and carotid intima-media thickness in children and adolescents with type 1 diabetes mellitus. J Clin Diagn Res. 2017;11(9):SC01–SC05.
  5. Krawczuk-Rybak M, Tomczuk-Ostapczuk M, Panasiuk A, Goscik E. Carotid intima-media thickness in young survivors of childhood cancer. J Med Imaging Radiat Oncol. 2017;61(1):85–92.
  6. Vatanen A, Sarkola T, Ojala TH, et al. Radiotherapy-related arterial intima thickening and plaque formation in childhood cancer survivors detected with very-high resolution ultrasound during young adulthood. Pediatr Blood Cancer. 2015;62(11):2000–2006.
  7. Bonafini S, Giontella A, Tagetti A, et al. Markers of subclinical vascular damages associate with indices of adiposity and blood pressure in obese children. Hypertens Res. 2019;42(3):400–410. doi:10.1038/s41440-018-0173-7
  8. Kollias A, Psilopatis I, Karagiaouri E, et al. Adiposity, blood pressure, and carotid intima-media thickness in Greek adolescents. Obesity (Silver Spring). 2013;21(5):1013–1017.
  9. Lipshultz SE, Adams MJ, Colan SD, et al; American Heart Association Congenital Heart Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: Pathophysiology, course, monitoring, management, prevention, and research directions. A scientific statement from the American Heart Association. Circulation. 2013;128(17):1927–1995.
  10. Oeffinger KC. Are survivors of acute lymphoblastic leukemia (ALL) at increased risk of cardiovascular disease? Pediatr Blood Cancer. 2008;50(2 Suppl):462–467.
  11. Kubota M, Nakata R, Adachi S, et al. Plasma homocysteine, methionine and S-adenosylhomocysteine levels following high-dose methotrexate treatment in pediatric patients with acute lymphoblastic leukemia or Burkitt lymphoma: Association with hepatotoxicity. Leuk Lymphoma. 2014;55(7):1591–1595.
  12. Sandoo A, van Zanten JJ, Metsios GS, Carroll D, Kitas GD. The endothelium and its role in regulating vascular tone. Open Cardiovasc Med J. 2010;4:302–312.
  13. Vora A, Goulden N, Wade R, et al. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): A randomised controlled trial. Lancet Oncol. 2013;14(3):199–209.
  14. Pui CH, Pei D, Campana D, et al. A revised definition for cure of childhood acute lymphoblastic leukemia. Leukemia. 2014;28(12):2336–2343. doi:10.1038/leu.2014.142
  15. Levy E, Samoilenko M, Morel S, et al. Cardiometabolic risk factors in childhood, adolescent and young adult survivors of acute lymphoblastic leukemia: A Petale Cohort. Sci Rep. 2017;7:17684. doi:10.1038/s41598-017-17716-0
  16. Nottage KA, Ness KK, Li C, Srivastava D, Robison LL, Hudson MM. Metabolic syndrome and cardiovascular risk among long-term survivors of acute lymphoblastic leukaemia: From the St. Jude Lifetime Cohort. Br J Haematol. 2014;165(3):364–374.
  17. Juonala M, Magnussen CG, Venn A, et al. Influence of age on associations between childhood risk factors and carotid intima-media thickness in adulthood: The Cardiovascular Risk in Young Finns Study, the Childhood Determinants of Adult Health Study, the Bogalusa Heart Study, and the Muscatine Study for the International Childhood Cardiovascular Cohort (i3C) Consortium. Circulation. 2010;122(24):2514–2520.
  18. Giordano P, Muggeo P, Delvecchio M, et al. Endothelial dysfunction and cardiovascular risk factors in childhood acute lymphoblastic leukemia survivors. Int J Cardiol. 2017;228:621–627.
  19. Järvelä LS, Niinikoski H, Heinonen OJ, Lähteenmäki PM, Arola M, Kemppainen J. Endothelial function in long-term survivors of childhood acute lymphoblastic leukemia: Effects of a home-based exercise program. Pediatr Blood Cancer. 2013;60(9):1546–1551.
  20. Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004–2006–2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290–296.
  21. Doyon A, Kracht D, Bayazit AK, et al. Carotid artery intima-media thickness and distensibility in children and adolescents: Reference values and role of body dimensions. Hypertension. 2013;62(3):550–556.
  22. Wühl E, Witte K, Soergel M, Mehls O, Schaefer F; German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: Normalized reference values and role of body dimensions. J Hypertens. 2002;20(10):1995–2007.
  23. Ociepa T, Bartnik M, Zielezińska K, Urasiński T. Prevalence and risk factors for arterial hypertension development in childhood acute lymphoblastic leukemia survivors. J Pediatr Hematol Oncol. 2019;41(3):175–180.
  24. Veringa SJ, van Dulmen-den Broeder E, Kaspers GJ, Veening MA. Blood pressure and body composition in long-term survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2012;58(2):278–282.
  25. Vijayasarathi A, Goldberg SJ. Comparison of carotid intima-media thickness in pediatric patients with metabolic syndrome, heterozygous familial hyperlipidemia and normals. J Lipids. 2014;2014:546863. doi:10.1155/2014/546863
  26. Lande MB, Carson NL, Roy J, Meagher CC. Effects of childhood primary hypertension on carotid intima media thickness: A matched controlled study. Hypertension. 2006;48(1):40–44.
  27. Saultier P, Auquier P, Bertrand Y, et al. Metabolic syndrome in long-term survivors of childhood acute leukemia treated without hematopoietic stem cell transplantation: An L.E.A. study. Haematologica. 2016;101(12):1603–1610.
  28. Mertens AC, Yasui Y, Neglia JP, et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: The Childhood Cancer Survivor Study. J Clin Oncol. 2001;19(13):3163–3172.
  29. Tomiyama H, Ishizu T, Kohro T, et al. Longitudinal association among endothelial function, arterial stiffness and subclinical organ damage in hypertension. Int J Cardiol. 2018;253:161–166.
  30. Urbina EM. Abnormalities of vascular structure and function in pe­diatric hypertension. Pediatr Nephrol. 2016;31(7):1061–1070.
  31. Chhabra N. Endothelial dysfunction: A predictor of atherosclerosis. Internet J Med Update. 2009;4(1):33–41.
  32. Ociepa T, Bartnik M, Zielezinska K, Prokowska M, Urasinska E, Urasinski T. Abnormal correlation of circulating endothelial progenitor cells and endothelin-1 concentration may contribute to the development of arterial hypertension in childhood acute lymphoblastic leukemia survivors. Hypertens Res. 2016;39(7):530–535.
  33. Dawson JD, Sonka M, Blecha MB, Lin W, Davis PH. Risk factors associated with aortic and carotid intima-media thickness in adolescents and young adults: The Muscatine Offspring Study. J Am Coll Cardiol. 2009;53(24):2273–2279.
  34. Baroncini LA, Sylvestre Lde C, Pecoits Filho R. Assessment of intima-media thickness in healthy children aged 1 to 15 years. Arq Bras Cardiol. 2016;106(4):327–332.
  35. Wiegman A, de Groot E, Hutten BA, et al. Arterial intima-media thickness in children heterozygous for familial hypercholesterolaemia. Lancet. 2004;363(9406):369–370.
  36. Children’s Oncology Group. Long-term Follow-up Guidelines for Survivors of Childhood, Adolescent and Yound Adult Cancer. Version 5.0 – October 2018. http://www.survivorshipguidelines.org/pdf/2018/COG_LTFU_Guidelines_v5.pdf. Monrovia, CA: Children’s Oncology Group; 2018.
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