Abnormal Myocardial Strain Indices in Children Receiving Anthracycline Chemotherapy

Abstract

Anthracycline chemotherapy (AC) is associated with impaired left ventricular (LV) systolic function. LV ejection fraction (EF %) obtained by two-dimensional echocardiography is the current gold standard for detection and monitoring of LV systolic function. However, dependence on LVEF has been shown to be unreliable due to its inherent limitations. Speckle tracking echocardiography (STE) measures myocardial strain and is a sensitive method to detect LV systolic dysfunction with demonstrated utility in such detection in adult and pediatric cohort studies. Compare myocardial strain indices derived by STE with LVEF to detect ACT-induced LV systolic dysfunction. Prospective, cross-sectional measurements of LV myocardial strain indices derived from STE with LVEF. Pediatric cohort of 25 patients (pts): 17 females, eight males with a mean age 9.8 ± 5.8 years, who received anthracyclines (AC); median cumulative dose ≥150 ± 124.4 mg/m(2), range 60-450 mg/m(2) showing normal LV end-diastolic diameter (mm) and normal LVEF (≥55 %) underwent STE to obtain LV myocardial strain indices: strain and strain rate. The inter- and intraobserver variability for the strain indices was 5 %. Fifteen of 25 pts (60 %) showed abnormal global longitudinal peak systolic strain (GLPSS) and 19/25 pts (76 %) showed abnormal peak circumferential strain (PCS) compared to age-matched controls (p = 0.005). In contrast, no significant differences was observed in either indices with the dose of AC. Likewise, no significant changes in the systolic or diastolic strain rate were noted with the dose of AC (r (2) = 0.0076 for peak E, r (2) = 0.072 for peak A, p = NS). GLPSS and PCS were diminished and, however, correlated poorly with the cumulative dose of AC. These observations indicate an early onset of LV systolic dysfunction by the strain indices in pts who continue to show a normal LVEF implying presence of occult LV systolic dysfunction. These novel strain indices may assist in early detection of LV systolic dysfunction with implications for monitoring and prevention of AC-induced LV systolic dysfunction.

Natural history of myocardial deformation in children, adolescents, and young adults exposed to anthracyclines: Systematic review and meta‐analysis

“…Seven studies investigated strain during or less than 1 year after anthracycline exposure (Table ). All studies assessed strain at baseline and over the course of chemotherapy, except Pignatelli et al who measured myocardial strain only posttreatment. Several studies (3 of 7 studies) compared posttreatment patients to healthy controls or reference values in healthy children .…”

“…All studies assessed strain at baseline and over the course of chemotherapy, except Pignatelli et al who measured myocardial strain only posttreatment. Several studies (3 of 7 studies) compared posttreatment patients to healthy controls or reference values in healthy children . Ganame et al used TDI while 2DSTE was used in the other studies.…”

Carvedilol Administration Can Prevent Doxorubicin-Induced Cardiotoxicity: A Double-Blind Randomized Trial

“…These monitoring parameters are deficient in early detection of subclinical cardiomyopathy because alterations in them occur when cardiac dysfunction is irreversible [10,11]. Some studies suggest that strain and strain-rate parameters are more sensitive than LVEF for early detection of myocardial systolic changes [12,13,14,15,16,17] and their decline implies occult left ventricle (LV) dysfunction [18], although their clinical value in this prediction remains questionable [19]. …”

State of the art review: Chemotherapy-induced cardiotoxicity in children

“…Pignatelli et al studied 25 pediatric cancer patients at risk for CIC, who had received 60–450 mg/m 2 and had a normal LVEF ≥55% . Fifteen of the 25 (60%) had abnormal global longitudinal peak systolic strain, and 19 (76%) had abnormal peak circumferential strain, when compared to age‐matched controls (Figure ).…”

“…This demonstrates impaired ventricular deformation (strain) in those exposed to anthracycline across all age groups. Reproduced with permission from Springer…”