The Value of Echocardiography Versus Cardiac Troponin I levels in the Early Detection of Anthracycline Cardiotoxicity in Childhood Acute Leukemia: Prospective Evaluation of a 7-Year-Long Clinical Follow-up

Abstract

The present study was designed to evaluate the significance of echocardiography versus cardiac troponin I levels in early detection of anthracycline dependent cardiotoxicity in acute lymphoblastic leukemia (ALL) patients. A total of 276 pediatric ALL patients were included in the study prospectively along 3 phases of data collection lasted from 2002 to 2009; including phase I (March 2002 to February 2003; n = 25; 53.3% females), phase II (September 2003 to April 2004; n = 35; 57.1% females), and phase III (January 2005 to June 2009; n = 216; 52.7% females) with respect to cumulative anthracycline doses applied. Anthracycline was administered in accordance with berlin-Franfurt-Munich (BFM)-2000 protocol in doses of 30 to 350 mg/m(2) (in the first phase) and 30 to 240 mg/m(2) (in the following phases). Evaluation of cardiotoxicity was performed via echocardiography and measurement of cardiac troponin I levels. Patients in each phase were homogenous in terms of gender and age. Diastolic dysfunction determined via reduction E/A ratio below the cutoff value was demonstrated to deteriorate earlier than systolic functions and alteration in cardiac enzymes. Being similar between dose groups, cTnI levels were shown to rise in the presence of congestive heart failure. In conclusion, anthracycline cardiotoxicity appears to be detected in an earlier stage by using diastolic parameters compared to systolic parameters and cardiac enzymes.

Cardiac biomarkers indicate a need for sensitive cardiac imaging among long-term childhood cancer survivors exposed to anthracyclines

“…*Abnormal value. cTnI was not useful in the detection of an early stage anthracycline-associated cardiotoxicity (20). El-Shitany et al (21) showed an elevation during treatment to be associated with an impaired systolic function and pretreatment with carvedilol seemingly protective.…”

“…Few studies have reported on paediatric patients during malignancy treatment (20,21) and only one during later follow-up (13). One reported that Tables 2 and 3.…”

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

“…TnI is more feasible than the other cardiac troponins for early CIC diagnosis due to its kinetic curve [18], but the exact dynamic of troponin release into bloodstream is not well known [5,12,19]. Although several papers have been published regarding CIC evaluation by troponin measurements, there are only a few studies on this subject in pediatric ALL setting [20][21][22][23][24][25][26][27][28][29]. Different groups monitored large cohorts of children with ALL and concluded that TnI was predictable for myocardial injury [20][21][22].…”

Successful recovery and allogeneic stem cell transplant following chemotherapy-induced severe cardiomyopathy: literature review of management and prognostic factors

“…Monitoring purely based on symptoms might miss the chance to detect cardiotoxicity early and may eventually lead to an irreversible cardiac failure. Cardiac biomarkers and dynamic imaging studies such as 2D echocardiography can help in the early detection of AIC 10. Dobutamine stress Echo, nuclear ventriculography and cardiac MRI are other effective tools to assess for cardiac damage in the setting of ongoing chemotherapy but relatively time-consuming 11…”