Strain Echocardiography in Early Detection of Doxorubicin-Induced Left Ventricular Dysfunction in Children with Acute Lymphoblastic Leukemia

Abstract

Objective. To investigate the ability of two-dimensional longitudinal strain echocardiography (2DST), to detect the early doxorubicin cardiotoxicity. Patients and Methods. The study included 25 children with newly diagnosed acute lymphoblastic leukemia (ALL) aged 5–15 years and 30 healthy control children. They had echocardiographic examination with conventional 2-dimensional (2D), pulsed tissue Doppler (PTD), and 2DST echocardiography before and within 1 week after doxorubicin treatment. Results. There was no significant difference in left ventricle (LV) systolic and diastolic functions measured by conventional 2-D and PTD echocardiography between patients and controls. However, there was significant decrease in LV global and peak systolic strain detected by 2-DST echocardiography in study group than control. After doxorubicin treatment, there was no significant difference in LV systolic and diastolic functions measured by conventional 2-D and PTD echocardiography than before treatment except for prolonged IVCT and IVRT, but LV global and peak systolic strain was significantly lower after treatment. Conclusion. 2-D longitudinal strain echocardiography was more sensitive than conventional 2-D and PTD in detecting the early LV doxorubicin-induced cardiotoxicity in children with ALL.

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

“…The results indicate that GLS is lower in anthracycline‐treated patients as compared to a normal, age‐matched population (SMD Total [fixed effects] = −0.695; SMD Total [random effects] = −0.810 [both P < .001]; Level II evidence). There was a significant difference among the findings of the included 9 articles ( X 2 = 44.06, P < .001), and the inconsistency among included articles was quantified as I 2 = 81.84% (95% CI =66.7–90.1). Doses are reported as mean ± SD unless noted otherwise.…”

“…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 .…”

“…Seven studies [27][28][29][30][31][32][33] investigated strain during or less than 1 year after anthracycline exposure ( Table 1). All studies assessed strain at baseline and over the course of chemotherapy, [27][28][29][30][31]33 31,33 or reference values in healthy children. 32 Ganame et al 27 used TDI while 2DSTE was used in the other studies.…”

“…There was no statistically significant difference among the findings of the included 6 articles 27-31,33 (X 2 = 10.32, P = .067), and the inconsistency among included articles was quantified as I 2 = 51.56% (95% CI = 0-80.7). The reported decreases in GLS after treatment based on the 6 included papers [27][28][29][30][31]33 are moderately heterogeneous. Doses are reported as mean ± SD unless noted otherwise.…”

Evaluation of Cardiotoxicity via Speckle-Tracking Echocardiography in Patients Treated with Anthracyclines

“…Al-Biltagi et al [17] compared 25 children with a diagnosis of acute lymphocytic leukemia (ALL) who received doxorubicin therapy and a control group; before and after the treatment, the basal STE values in the patients were lower than those in the control group, which was reported to be due to the hyper-dynamic state (anemia, tachycardia, etc.) of the patients as a result of leukemia.…”