Pediatric malignancies: Is the prechemotherapy left ventricular function normal?

Akam‐Venkata, Jyothsna; Kadiu, Gilda; Galas, James; Aggarwal, Sanjeev

doi:10.1111/echo.14461

Cited by 8 publications

(4 citation statements)

References 27 publications

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“…Other studies in chemotherapy-naive cancer patients yielded conflicting results regarding LV volume, LV mass, and strain amplitude. These differences can be likely attributed to differences in methodology, as well as different malignancies [7][8][9]. Interestingly, both heart rate and cardiac output can be reduced with medications such as β-blockers [10].…”

Section: Changes In Cardiac Output Statesmentioning

confidence: 99%

Cancer-Induced Resting Sinus Tachycardia: An Overlooked Clinical Diagnosis

Sakellakis,

Reet,

Kladas

et al. 2024

Preprint

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Elevated resting heart rate is frequently observed in cancer patients, and is associated with increased mortality. Although specific chemotherapeutic agents can induce cardiotoxicity, the presence of sinus tachycardia in chemotherapy-naive patients suggests other factors likely contribute to this clinical presentation. Despite its prevalence, cancer-associated resting sinus tachycardia has not been fully recognized and comprehensively described as a separate clinical entity. Secondary effects of cancer, especially structural cardiac changes, secretory factors (inflammatory cytokines), and thromboembolic disease can cause resting tachycardia. Alternatively, rapid heart rate may reflect compensatory mechanisms responding to increased metabolic demands, raised cardiac output states, and even pain. Hence, cancer-associated tachycardia presents a clinical dilemma; acute life-threatening conditions (such as sepsis, pulmonary embolism, etc.) must be ruled out, but cancer itself can explain resting sinus tachycardia and more conservative management can avoid unnecessary testing, cost and patient stress. Furthermore, identification and management of cardiac conditions associated with cancer may improve survival and the quality of life of cancer patients.

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Section: Changes In Cardiac Output Statesmentioning

confidence: 99%

Cancer-Induced Resting Sinus Tachycardia: An Overlooked Clinical Diagnosis

Sakellakis,

Reet,

Kladas

et al. 2024

Preprint

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“…1 The investigators included pediatric patients with various malignancies and compared them with healthy children. 1 The investigators included pediatric patients with various malignancies and compared them with healthy children.…”

Section: Left Ventricular Dysfunction Before Chemotherapy: Did We Mismentioning

confidence: 99%

Left ventricular dysfunction before chemotherapy: Did we miss something?

Tadić

Cuspidi

2019

Echocardiography

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We have read with a great interest the article by Akam-Venkata et al regarding left ventricular (LV) function and mechanics in pediatric patients who still did not receive chemotherapy. 1 The investigators included pediatric patients with various malignancies and compared them with healthy children. The results showed that LV longitudinal strain was significantly lower in chemotherapy-naïve young patients than in healthy children despite similar values of LV ejection fraction, myocardial performance index, and shortening fraction. 1 The data were same for solid and hematological tumors. LV circumferential and radial strains were not assessed in this study. This is very important topic, which has not been sufficiently investigated so far. Mavinkurve-Groothuis et al reported a significant reduction in LV longitudinal, circumferential, and radial strains in the children with acute lymphoblastic leukemia after anthracycline therapy than before treatment. 2 Even though the researchers did not make statistical comparison in LV mechanics between healthy controls and cancer patients before chemotherapy, it was clear that LV longitudinal and circumferential strains were remarkably lower and that LV radial strain was remarkably higher, in the children with leukemia before chemotherapy than in healthy children. 2 In the adult population were obtained similar results. Assuncao et al in the adult patients with acute leukemia found significantly lower values of LV longitudinal strain than in healthy controls. 3 Our research group recently published studies in which it was shown not only that LV multidirectional strain (longitudinal, circumferential, and radial) was significantly decreased in chemotherapy-and radiotherapy-naïve patients with solid cancer, but also that right ventricular (RV) longitudinal strain was significantly reduced in the cancer patients in comparison with controls. 4,5 The difference existed not only in the global values of LV and RV strains, but also in layer-specific strain, which further implies transmural myocardial and not endocardial impairment, as it was usually presumed.The most important question that has been imposed from these studies is the potential mechanism(s) of this relationship. Why and how cancer could interfere cardiac function? All mentioned investigations showed that conventional parameters of LV and RV systolic function were similar between cancer patients and controls. On the other hand, all researches agree that mechanical function was deteriorated in the cancer patients independently of their age. There are several speculations on this topic: increased inflammation, elevated vasoactive peptides (endothelin, copeptin), pro-BNP, pro-ANP, and troponin T, impaired oxidative stress, or even direct infiltration of the myocardium by circulating cancer cells. To our knowledge, there are no studies designed to answer the questions regarding mechanisms responsible for cardiac dysfunction in the cancer patients. Considering the fact that most of the cancer patients are treated with cardioto...

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“…Among our population of pediatric cancer patients, the patients with leukemia had significant lower Hb compared to the group with solid tumors (Hb 8.4 ± 3.3, 11.4 ± 3.6 P < .001*). However, the LVGLS was equally decreased in both groups of patients (−19.5 ± 2.4 vs −19.2 ± 2.9, P ‐ .7) . There is another proposed theory of infiltration of the myocardium by circulating cancer cells leading to cardiac dysfunction.…”

mentioning

confidence: 90%

“…We would like to thank Dr Tadic and colleague for their interest in our research manuscript titled "Pediatric Malignancies: Is the Pre‐chemotherapy Left Ventricular Function Normal? " and their contribution in the research related to chemotherapy‐induced cardiomyopathy. Tadic et al have recently published their research findings of abnormal left ventricular (LV) systolic function in 122 chemotherapy naïve and radiotherapy naïve cancer patients (prechemotherapy) and 45 age‐matched controls.…”

mentioning

confidence: 99%

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

et al. 2020

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We would like to thank Dr Tadic and colleague for their interest in our research manuscript titled "Pediatric Malignancies: Is the Pre-chemotherapy Left Ventricular Function Normal?" 1 and their contribution in the research related to chemotherapy-induced cardiomyopathy. Tadic et al have recently published their research findings of abnormal left ventricular (LV) systolic function in 122chemotherapy naïve and radiotherapy naïve cancer patients (prechemotherapy) and 45 age-matched controls. They reported signifition exists, which can be detected by the speckle tracking echocardiography. As more and more research data are being published, we propose adding the speckle echocardiography for assessing the LV systolic function in patients even before they have received chemotherapy. This may help stratify high-risk patients who are at risk for chemotherapy and radiotherapy induced cardiotoxicity.Jyothsna Akam-Venkata MBBS

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Pediatric malignancies: Is the prechemotherapy left ventricular function normal?

Cited by 8 publications

References 27 publications

Cancer-Induced Resting Sinus Tachycardia: An Overlooked Clinical Diagnosis

Cancer-Induced Resting Sinus Tachycardia: An Overlooked Clinical Diagnosis

Left ventricular dysfunction before chemotherapy: Did we miss something?

Prechemotherapy subclinical left ventricular dysfunction: Do we know the mechanism?

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