ASECHO Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children Guideline Summary

Introduction

During cancer treatment inclusive of cardiotoxic medications, echocardiographic screening for early detection of subclinical cardiac dysfunction is recommended. The frequency of screening will depend on doses used and other coexisting risk factors.
Current criteria for defining early cardiac dysfunction are based on decreased FS or EF that have been poorly validated in prospective studies. Withholding cancer treatment requires multidisciplinary decision-making and must be made cautiously.
After completion of treatment, cardiac surveillance is recommended at least every 2 years for high-risk and every 5 years for moderate-risk patients. The cost-benefit for low-risk patients is questionable, and evidence-based recommendations for cardiac surveillance after novel treatments have not been established.

Serial assessment of LV chamber size and wall thickness must be included when evaluating children with cancer before, during, and after treatment.
Linear dimensions of the LV cavity, interventricular septum, and posterior wall can be measured either by M-mode echocardiography or by 2D echocardiography. Consistency in the method used for measuring linear dimensions is crucial for interpreting serial changes. The measurements should be corrected for body size, and Z scores should be included in the reports.
Left ventricle volume and mass measured by 2D echocardiography using the method of disks or the area-length method can provide additional and more detailed information on LV size.
Three-dimensional echocardiography is an emerging technique in pediatrics for assessing LV volume and mass without geometric assumptions.

Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children