Childhood cancer survivors carry hidden heart risks despite normal scans

Long-term survivors of childhood cancer who received anthracycline chemotherapy show a striking pattern: common cardiovascular risk factors such as high blood pressure, overweight and physical inactivity are widespread, yet standard echocardiographic measures of heart function remain largely normal. A retrospective cross-sectional study from a single center, published in the journal Cardio-Oncology, examined 97 survivors exposed to anthracyclines, with or without thoracic radiotherapy, and found that higher cumulative anthracycline exposure was associated with higher concentrations of the cardiac biomarker NT-proBNP, even after adjustment for age, sex, body mass index and renal function.

The study, led by Beatriz Vergara Muñoz and colleagues including Luis Madero López, assessed cardiovascular risk factors and biomarkers during 2024–2025, while echocardiographic data were drawn retrospectively from the most recent routine follow-up examination and were not contemporaneous with the biomarker assessment. Median time since completion of cancer treatment was 13.7 years.

Overweight or obesity was present in 29.9 percent of survivors, elevated or hypertensive-range blood pressure in 49.5 percent, hypercholesterolemia in 21.6 percent, and physical inactivity in 20.6 percent.

Reduced left ventricular systolic function was identified in only 1 of the 85 survivors with available echocardiography, or 1.2 percent. No significant association was observed between cumulative anthracycline exposure and left ventricular ejection fraction, the standard measure of pumping capacity used in routine surveillance.

The biomarker results point in a different direction. Higher cumulative anthracycline exposure was associated with higher NT-proBNP concentrations, with a Spearman correlation coefficient of 0.38 and a p-value below 0.001. After adjustment for age, sex, body mass index and renal function, each 100 mg/m² increase in doxorubicin-equivalent dose was associated with a 12.2 pg/mL higher median NT-proBNP concentration, with a 95 percent confidence interval of 6.7 to 17.7 pg/mL and a p-value below 0.001.

The authors state that the clinical significance of the association between anthracycline exposure and higher NT-proBNP remains uncertain.

The single-center, retrospective cross-sectional design carries further constraints. Echocardiographic data came from the most recent routine examination rather than from assessments performed alongside the 2024–2025 biomarker measurements, so temporal relationships between exposure, biomarkers and imaging findings cannot be established.

The authors conclude that cardiovascular risk factors were common in this survivor cohort, whereas conventional echocardiographic findings were largely preserved. They emphasize that survivorship care should include systematic assessment of modifiable cardiovascular risk factors, and they call for prospective studies using contemporaneous biomarkers and advanced cardiac imaging to better characterize long-term cardiovascular risk in this growing population of childhood cancer survivors.

Subject of Research: Cardiovascular risk factors, NT-proBNP levels and echocardiographic findings in long-term survivors of childhood cancer exposed to anthracyclines

Article Title: Cardiovascular risk factors, NT-proBNP levels and echocardiographic findings in long-term survivors of childhood cancer exposed to anthracyclines

Article References: Muñoz, B. V., Navarro, M. T., Gabriel, A. G., López, M. B., Marín, M. J. D. C., Orellana, M. R., & López, L. M. (2026). Cardiovascular risk factors, NT-proBNP levels and echocardiographic findings in long-term survivors of childhood cancer exposed to anthracyclines. Cardio-Oncology. https://doi.org/10.1186/s40959-026-00598-5

Image Credits: AI Generated

DOI: 10.1186/s40959-026-00598-5

Keywords: childhood cancer survivors, anthracyclines, NT-proBNP, echocardiography, cardiovascular risk factors, cardio-oncology, left ventricular function, doxorubicin-equivalent dose, survivorship care, biomarkers, Cardiovascular, risk