Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography

Akam‐Venkata, Jyothsna; Kadiu, Gilda; Galas, James; Lipshultz, Steven E.; Aggarwal, Sanjeev

doi:10.1017/s1047951119002622

Cited by 23 publications

(22 citation statements)

References 32 publications

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“…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.…”

Section: Speckle Tracking Imaging and 3d Echocardiographymentioning

confidence: 99%

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

et al. 2021

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BackgroundIn childhood cancer survivors (CCSs) anthracycline-related cardiotoxicity is an important cause of morbidity and late mortality, but the optimal modality of cardiac surveillance still remains to be defined. The aim of this study was to assess whether non-invasive echocardiography-based functional cardiac measures can detect early subclinical myocardial changes in long-term pediatric cancer survivors who received anthracycline therapy.MethodsTwenty anthracycline-treated long-term CCSs and 20 age, sex, and body surface area matched healthy controls were enrolled in this study. Among cancer survivors, mean age at diagnosis was 6.5 ± 4.4 years, and the mean cumulative anthracycline dose was 234.5 ± 87.4 mg/m2. All subjects underwent a comprehensive functional echocardiographic protocol study including two-dimensional echocardiography (2D Echo), tissue Doppler imaging (TDI), speckle tracking (STE) and three-dimensional echocardiography (3D Echo). Patients were studied at a mean follow-up time of 6.5 ± 2.8 years from the end of therapy.ResultsNo significant differences in two-dimensional left ventricle ejection fraction (LVEF), diastolic parameters and speckle tracking (STE)-derived myocardial strain were observed between patients treated with anthracyclines and controls. Myocardial performance index was significantly prolonged (p = 0.005) and three-dimensional LVEF was significantly reduced (p = 0.002) in CCSs compared to controls, even though most values were within the normal range. There were no significant correlations between 2D, STE, and 3D echocardiographic parameters and age at diagnosis or duration of follow-up. No significant differences in echocardiographic parameters were found when stratifying cancer patients according to established risk factors for anthracycline cardiomyopathy.ConclusionsThis study found significantly reduced three-dimensional LVEF in CCSs compared with controls, despite no significant differences in two-dimensional LVEF and longitudinal strain values. These findings suggest that long-term CCSs who had received anthracycline therapy may be found to have subclinical features of myocardial dysfunction. However, further studies are needed to demonstrate the validity of new imaging techniques, including STE and 3D Echo, to identify patients at risk for cardiomyopathy in the long-term follow-up of CCSs.

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Section: Speckle Tracking Imaging and 3d Echocardiographymentioning

confidence: 99%

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

et al. 2021

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“…Significant reductions in LV longitudinal strain in subendocardial segments were observed after 3 cycles of chemotherapy, while conventional LV systolic and diastolic conventional parameters, as well as LVEF, were relatively spare (36). Other studies have reported that LV regional wall motion abnormalities are closely associated with the development of cancer therapy-related cardiac dysfunction in patients undergoing chemotherapy and may also be an important predictor of DIC (37)(38)(39)(40)(41). To the best of our knowledge, we are the first to use strain analysis to evaluate the cardioprotective effect of a natural highaltitude environment on DIC.…”

Section: Discussionmentioning

confidence: 95%

Protective effect of a chronic hypobaric hypoxic environment at high altitude on cardiotoxicity induced by doxorubicin in rats: a 7 T magnetic resonance study

Wan¹,

Zhu²,

He³

et al. 2022

Quant Imaging Med Surg

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Background: Doxorubicin (DOX)-induced cardiotoxicity (DIC), a major clinical problem, has no effective preventive therapies. We hypothesized that left ventricular (LV) systolic function would be improved in a chronic hypobaric hypoxia environment at high altitude. The purpose of this study was to investigate whether cardiovascular magnetic resonance could reveal the cardioprotective effect of chronic hypobaric hypoxia on DIC.Methods: In total, 60 rats were randomly assigned to 1 of 6 groups (n=10 per group): the P group (plain), PD group (plain + DOX), HH group (high altitude), HHD4 group (high altitude + DOX for 4 weeks), HHD8 group (high altitude + DOX for 8 weeks), and HHD12 group (high altitude + DOX for 12 weeks). The rats were transported to either Yushu (altitude: 4,250 m) or Chengdu (altitude: 500 m) where they underwent intraperitoneal injection of DOX (5 mg/kg/week for 3 weeks) or saline. Preclinical 7 T cardiovascular magnetic resonance was performed at weeks 4, 8, and 12. Tissue tracking was used to measure LV cardiac function and to analyze global and segmental strains. Subsequently, histological and oxidative stress tests were performed to evaluate the protective effect of a high-altitude environment on DIC. Results:The left ventricular ejection fraction (LVEF) and global and regional strains in the middle, apical, anterior, septal, inferior, and lateral segments (all P<0.05) were improved in the HHD4 group compared with the PD group. The global strain was significantly greater in absolute value in the HHD8 and HHD12 groups than in the HHD4 group (all P<0.05). Additionally, histological and enzyme-linked immunosorbent assay evaluations supported the in vivo results.Conclusions: A chronic hypobaric and hypoxic environment at high altitude partially prevented cardiac dysfunction and increased global and regional strain in DIC rat models, thereby minimizing myocardial injury and fibrosis. In addition, by increasing the total duration of chronic hypobaric hypoxia, the global strain was further increased, which was likely due to reduced oxidative stress.

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“…The prevalence of anthracycline cardiotoxicity is increased because of improved new diagnostic methods and close followup periods (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). To detect cardiac damage, the diagnostic approach adopted was based mainly on the estimation of left ventricular ejection fraction (LVEF) or left ventricular fractional shortening (LVFS).…”

Section: Discussionmentioning

confidence: 99%

“…Çilsal et al (24) showed a deterioration in the LV longitudinal strain index with STE in pediatric patients with cancer receiving anthracycline treatment. Akam-Venkata et al (22) demonstrated that asymptomatic patients with anthracycline-treated childhood cancer with normal left ventricular fractional shortening had lower global longitudinal and circumferential strain, and left ventricular longitudinal strain was lower in the majority of the segments. Thus, they thought that anthracycline cardiotoxicity was more global than regional.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of early-onset cardiotoxic effects of anthracyclines used during the treatment of childhood acute lymphoblastic leukemia by speckle-tracking echocardiography

Bilir¹,

Çetin²,

Kaçar³

et al. 2022

The Anatolian Journal of Cardiology

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Objective: Anthracyclines are widely used in the treatment of acute lymphoblastic leukemia (ALL). However, cardiotoxicity is the most critical side effect that requires dose limitation. It is thought to occur at first exposure, but the clinical presentation may occur years later. In this study, we aimed to determine the time of initial damage and cardiotoxicity that develops in children with ALL. Methods: In this prospective study, 13 patients with newly diagnosed intermediate-risk precursor B cell ALL treated with the ALL-IC BFM 2009 protocol were included. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were performed in all the patients before chemotherapy, after completing the induction phase, and at the end of the reinduction phase. Results: The mean age of the patients was 7.8±4.6 (3.1-16.3) years. Myocardial velocity during systole (S m ) determined by TDI at the interventricular septum significantly decreased during the induction phase. Despite a decrease in STE parameters, a statistically significant reduction was determined in the global longitudinal strain rate at both left and right ventricles at the end of the induction. Nevertheless, a statistically significant increase was observed among the conventional echocardiographic findings in the left ventricular end-diastolic diameter at the end of the reinduction. Conclusion: During the treatment of ALL, subclinical anthracycline-associated cardiotoxicity develops in the early stages of treatment. The findings detected by TDI and STE could be missed by conventional echocardiography. We recommend evaluating patients with these newly developed techniques to detect subclinical cardiotoxicity at an early stage and starting appropriate therapy on time.

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Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography

Cited by 23 publications

References 32 publications

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

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

Protective effect of a chronic hypobaric hypoxic environment at high altitude on cardiotoxicity induced by doxorubicin in rats: a 7 T magnetic resonance study

Evaluation of early-onset cardiotoxic effects of anthracyclines used during the treatment of childhood acute lymphoblastic leukemia by speckle-tracking echocardiography

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