Note from Prof. Steven Lipshultz, Editor-in-Chief of Cardio-Oncology, and Miriam Mestre, Managing Editor. This inaugural conference was jointly sponsored by Sofia’s Hope, the Cincinnati Children’s Heart Institute, and Oishei Children’s Hospital/Jacobs School of Medicine and Biomedical Sciences, University at Buffalo. The “Cardio-Oncology Journal Prize” for top original research posters was sponsored by BMC. The Steering Committee was comprised of world-renowned leaders in cardio-oncology and the meeting brought together thought-leaders, practitioners, and advocates in the field of pediatric cardio-oncology for a uniquely focused session. Plans are currently underway for the next conference in 2024.

Christina Yang, University of Washington-Seattle Children’s Hospital, USA
Abstract: “Machine Learning has Potential to Assist in Identification of Children at High Risk for Treatment-Related Cardiomyopathy through Echocardiography”
I am a third year pediatric resident at the University of Washington-Seattle Children’s Hospital and am planning to start a fellowship in Pediatric Cardiology at Children’s National Hospital post residency. I have a background in Biomedical Engineering prior to medical school and a particular interest in global health and healthcare in resource-limited settings. My research in pediatric cardiology has previously focused on studying targeted-view echocardiogram for screening certain cardiac conditions, with the goal to eventually use AI for cardiac screening in resource-limited settings.

In this project, I collaborated with faculties from the Department of Cardiology, Fred Hutchinson Cancer Research Center, and the University of Washington Department of Bioengineering Cardiac System Stimulation Lab, and identified echocardiographic imaging clips in various views used for diagnosis of cardiomyopathy in children undergoing chemotherapy, and worked with the engineering team to develop a machine learning model with the goal of helping predict cardiomyopathy in childhood cancer survivors. My plan is to continue my research in machine learning and AI, and further apply this concept to improve cardiac screening in global as well as resource-limited settings.

Elizabeth (Lieke) A.M. Feijen-Allenstein, Princess Máxima Center for Pediatric Oncology, the Netherlands
Abstract: “Detection of abnormal values of cardiac function and associated markers in childhood cancer survivors: a cross-sectional study”
Cancer therapy-related heart dysfunction are major problems in long-term childhood cancer survivors. This study assessed the occurrence of abnormal heart function, EKG markers and blood markers in survivors compared to siblings. We invited 1291 survivors treated with cancer treatment that affects the heart and 271 siblings to the outpatient clinic to perform an echo of the heart, EKG, and draw blood for blood markers. The occurrence of abnormal heart function and abnormal blood markers is high in survivors and occurred much more in survivors than in siblings.

I am a senior health scientist in the Princess Máxima Center for Pediatric Oncology. My mission is to increase knowledge on cardiotoxicity in children with and after cancer, and on the total burden of disease in survivors after childhood cancer and to guide young PhD students in their careers.

Elvira van Dalen, Princess Máxima Center for Pediatric Oncology, the Netherlands
Abstract: “Primary cardioprotection with dexrazoxane in childhood cancer patients expected to receive anthracyclines: recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group”
I’m a senior clinical scientist/epidemiologist at the Princess Máxima Center for Pediatric Oncology in Utrecht, the Netherlands. My interest in cardiotoxicity after childhood cancer treatment started with an internship during my medical training, when a little girl was admitted to the ICU because of severe heart failure during her cancer treatment. This made the problem very real for me. I continued working in this field and I did my PhD thesis on anthracycline-induced cardiotoxicity during and after treatment for childhood cancer. My main research interests now are late effects after childhood cancer treatment, with a special focus on cardiovascular disease, and systematic reviews and guidelines in the pediatric oncology field.

During the conference I presented the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) guideline on cardio-protection with dexrazoxane in childhood cancer patients who are expected to receive anthracyclines. Little guidance was available on its use in children. Therefore, a team of international experts reviewed the existing literature and used evidence-based methodology to formulate recommendations. We concluded that the benefits of dexrazoxane probably outweigh the risk of subsequent neoplasms when the cumulative doxorubicin or equivalent dose is ≥250 mg/m² (moderate recommendation). However, there was insufficient evidence to make a recommendation for lower doses and we encourage further research. The guideline received enthusiastic responses from the audience and it has been an honor to be selected as one of the top abstracts. I’m very proud that the guideline now has been published in Lancet Child & Adolescent Health. Hopefully it will help prevent or reduce anthracycline-induced cardiotoxicity for many childhood cancer patients.

Takeshi Tsuda, Nemours Children’s Hospital Delaware; Thomas Jefferson University, USA
Abstract: “Surveillance Cardiopulmonary Exercise Testing Can Identify Childhood Cancer Survivors: Who are at Risk for Long-Term Cardiovascular Complications?”
Although survival after childhood cancer treatment has significantly improved in recent years, long-term cardiovascular complications have become a major concern in childhood cancer survivors. The chronic cardiovascular diseases are frequently insidious but pervasive and progressive, and early subclinical changes are difficult to identify in children. We have proposed a unique method in analyzing cardiopulmonary testing (CPET) as a useful screening tool to identify early abnormal changes in these patients. With this method, we were able to identify the contributing mechanisms, including decreased skeletal muscle mass, decreased stroke volume reserve, impaired muscle metabolism, and inefficient breathing pattern, in childhood cancer survivors. Physical conditioning and cardiovascular reserve are two mutually dependent factors that heavily influence future cardiovascular health and general wellness. We believe CPET is a useful screening method to identify subclinical cardiovascular abnormalities in childhood cancer survivors. With this approach, we will be able to sufficiently address the mechanisms of the subclinical changes frequently seen in these patients. Exercise is not only a way to assess cardiopulmonary reserve, but also an important therapeutic modality to enhance their future health resilience.

I am a senior pediatric cardiologist at Nemours Children’s Health Delaware. Currently I have been focusing on CPET and exercise physiology to assess cardiovascular reserve in patients with and without certain cardiac conditions. I am leading to build up the cardio-oncology program in our hospital by which early subclinical cardiovascular abnormality will be identified through multidisciplinary approach including routine CPET. We also emphasize the importance of education for these children to understand a basic concept of human health (diet, nutrition, exercise, and sleep) and to foster their responsibility, independence, and confidence for their future health. I serve as a Professor of Pediatrics, Sidney Kimmel Medical School at Thomas Jefferson University and have been involved in medical education and research mentorship.

Several years ago, I encountered three consecutive CPET cases where three adolescents with history of cancer treatment showed surprisingly poor exercise performance despite the fact that they were noted as asymptomatic with normal cardiac performance by echocardiogram. I was convinced that this is the population that had not been recognized as at risk of future cardiovascular disease. As I studied more about chemotherapy-mediated cardiotoxicity, I was fascinated by the complexity of the problem despite the depth of scientific endeavors to understand the mechanisms. At the same time, I realized that these otherwise unidentified patients may continue to exacerbate their underlying cardiac status to progress to advanced heart disease.