Evaluation of long-term cardiac side effects of anthracycline chemotherapy by conventional and non-conventional echocardiographic methods in childhood cancer survivors

Abstract

Objective:Anthracycline chemotherapeutic agents carry the well-recognised risk of cardiac toxicity. The aim of this study was to determine the long-term effect of anthracycline chemotherapy on the biventricular function in childhood cancer survivors using tissue Doppler imaging and two-dimensional speckle tracking echocardiography.Patients and Methods:The study included 45 survivors of childhood cancers and 50 healthy age-matched control patients. Cardiac function was prospectively studied with conventional echocardiography, tissue Doppler imaging, and speckle tracking echocardiography after completion of treatment. The same analysis was performed on matched controls.Results:There was no difference in age, gender, height, and weight between the study and control groups. The mean anthracycline dose was 240 ± 106 mg/m2 and the mean remission duration was 8.2 ± 5 years (1–20 years) in the study group. Conventional echocardiography showed similar ejection fraction, shortening fraction, and left ventricle end-diastolic diameter in both groups. Mitral lateral and septal tissue Doppler imaging showed normal but according to control group relatively sub-normal systolic and diastolic function in patient group. The global longitudinal and circumferential strain and strain rates were significantly lower in the patient group compared to control group. Correlation analysis revealed a negative and significant correlation between total anthracycline dose and global longitudinal and circumferential strain and strain rates.Conclusion:Sub-clinical systolic and diastolic dysfunction may not be detected by conventional echocardiographic methods which are frequently used in daily practice. Sub-clinical systolic and diastolic dysfunction may be detected more sensitively by echocardiographic method such as speckle tracking echocardiography in childhood cancer survivors.

Cardiotoxicity evaluation in pediatric patients with acute lymphoblastic leukemia – results of prospective study

“…Regarding SL, our results were similar to reported normal values [10,42]. Contraversely, some studies observed significant changes in SL after AC treatment [36].…”

“…The gold standard for CIC diagnosis is serial ultrasound [7], transthoracic echocardiography being the recommended method [8]. Due to frequent asymptomatic cardiotoxicity, more sensitive methods of diagnosis are required [9] and Tissue Doppler Imaging (TDI) provides a promising technique for evaluating cancer patients [10]. Cardiac biomarkers may represent an operator-independent alternative for CIC detection, but an optimal schedule of biomarker assessments remains unclear [11].…”

Cardiac Surveillance for Early Detection of Late Subclinical Cardiac Dysfunction in Childhood Cancer Survivors After Anthracycline Therapy

“…Unlike conventional LVSF and LVEF, which are limited to one plane, strain can be measured in three planes, providing a better determination of cardiac function. Previous studies provided evidence that strain abnormalities can be seen early despite preserved LVEF by conventional echo measures, identifying cardiac involvement in CCSs prior to the development of overt systolic dysfunction (43,(46)(47)(48)(49)(50)(51)(52)(53)(54). However, a more recent multicenter study of cardiac strain in a large cohort of pediatric CCSs found only mild differences in parameters of longitudinal strain between patients and healthy controls, with most CCSs (92.3%) having longitudinal strain values within the normal range.…”

Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues

“…This could result not only in prolonged survival but also, in improved quality of life. However, cardiac follow-up based on clinical signs and symptoms of heart failure will likely result in missing a substantial proportion of patients in the early stage of cardiac dysfunction [21]. Furthermore, with the increasing trend of new antineoplastic treatments and new combination therapies, where short-and long-term complications remain peculiar, it is extremely challenging for a clinician to promptly and adequately diagnose CTAC.…”