Background: Survival among children with central nervous system (CNS) tumors has improved markedly. However, long-term cardiac effects of craniospinal irradiation (CSI) remain poorly defined. Emerging data suggest an elevated risk for subclinical systolic dysfunction despite the absence of anthracycline exposure. Objectives: This study aimed to evaluate longitudinal echocardiographic measures of systolic and diastolic function following CSI and identify predictors of cardiac dysfunction. Methods: We conducted a retrospective, multi-institutional cohort study of pediatric patients diagnosed with a primary CNS tumor treated with CSI between January 2000 and September 2024. Echocardiographic assessments included M-mode left ventricular ejection fraction (LVEF), LV shortening fraction (LVSF), speckle-tracking global longitudinal strain (GLS), and Doppler-based diastolic indices. Longitudinal changes were modeled using linear mixed-effects models adjusted for demographic, treatment, cardiovascular, and endocrine variables. Results: Among 129 survivors (median age at diagnosis 8 years [IQR: 5-11]; at evaluation 23 years [IQR: 18-27]; median mean heart radiation dose 1,217 cGy [IQR: 2.340-3.600]), LVEF and LVSF declined progressively (P = 0.006 and P < 0.001). LVEF remained ≥50% in all patients, LVSF was <28% in 14 individuals. Diastolic parameters remained stable. GLS was assessed in 100 patients showing early post-CSI improvement followed by progressive decline (P < 0.001), 5 patients exhibited GLS <16%. Older age at diagnosis was associated with greater decline in LVEF and LVSF, while endocrine comorbidities correlated with lower LVEF as attained age increased. GLS trajectories differed by sex, with lower values in younger females. Conclusions: Progressive long-term decline in systolic function was observed in CSI-treated CNS tumor survivors despite modest cardiac radiation exposure. Age, sex, and endocrine comorbidities influence cardiac trajectories, supporting longitudinal cardiac surveillance.
Longitudinal Assessment of Cardiac Function After Craniospinal Irradiation in Pediatric Central Nervous System Tumor Survivors
Pozza, Alice;
2026
Abstract
Background: Survival among children with central nervous system (CNS) tumors has improved markedly. However, long-term cardiac effects of craniospinal irradiation (CSI) remain poorly defined. Emerging data suggest an elevated risk for subclinical systolic dysfunction despite the absence of anthracycline exposure. Objectives: This study aimed to evaluate longitudinal echocardiographic measures of systolic and diastolic function following CSI and identify predictors of cardiac dysfunction. Methods: We conducted a retrospective, multi-institutional cohort study of pediatric patients diagnosed with a primary CNS tumor treated with CSI between January 2000 and September 2024. Echocardiographic assessments included M-mode left ventricular ejection fraction (LVEF), LV shortening fraction (LVSF), speckle-tracking global longitudinal strain (GLS), and Doppler-based diastolic indices. Longitudinal changes were modeled using linear mixed-effects models adjusted for demographic, treatment, cardiovascular, and endocrine variables. Results: Among 129 survivors (median age at diagnosis 8 years [IQR: 5-11]; at evaluation 23 years [IQR: 18-27]; median mean heart radiation dose 1,217 cGy [IQR: 2.340-3.600]), LVEF and LVSF declined progressively (P = 0.006 and P < 0.001). LVEF remained ≥50% in all patients, LVSF was <28% in 14 individuals. Diastolic parameters remained stable. GLS was assessed in 100 patients showing early post-CSI improvement followed by progressive decline (P < 0.001), 5 patients exhibited GLS <16%. Older age at diagnosis was associated with greater decline in LVEF and LVSF, while endocrine comorbidities correlated with lower LVEF as attained age increased. GLS trajectories differed by sex, with lower values in younger females. Conclusions: Progressive long-term decline in systolic function was observed in CSI-treated CNS tumor survivors despite modest cardiac radiation exposure. Age, sex, and endocrine comorbidities influence cardiac trajectories, supporting longitudinal cardiac surveillance.
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