Tissue Doppler Imaging for anthracycline cardiotoxicity monitoring in pediatric patients with cancer

Abstract

Background: Cardiotoxic effects of anthracycline therapy are a major cause of morbidity for childhood cancer survivors. The aim of this retrospective evaluation is to assess the efficacy of Tissue Doppler Imaging in the early detection of myocardial alterations in these patients. Methods: A population of 50 childhood cancer survivors (32 males and 18 females) who have been treated with anthracyclines was evaluated by standard and TDI echocardiographic examination of the basal and median region of the interventricular septum (IVSb, IVSm), of the left ventricular posterior wall (LVPWb, LVPWm), and of the mitral annulus; the results were compared with those obtained from a population of 50 healthy age-matched and sex-matched controls by using the Student test. The clinical and echocardiographic data of the two groups were compared also with the independent samples t-test. All data were expressed as mean ± standard deviation. A two-tailed P-value < 0.05 was considered statistically significant. Statistical analysis was performed using STATA 7.0.Results: The case-control analysis showed statistically significant differences (p < 0,05) between the patients and the controls values. The systolic performance of the patients was normal (LVEF (p = 0,0029) and LVFS (p = 0,0002)). Statistically significant differences between patients and controls were found for diastolic function measurements obtained with PW Doppler such as IVRT (p = 0,0000), DT (p = 0,0041), E (p = 0,0000), A (p = 0,0458), even if E/A ratio was not altered. TDI analysis also show significant differences between patients and controls in both LVPW and IVS (basal and middle segments); E/E' ratio and E'/A' ratio did not vary significantly. Linear Regression and multivariate analysis showed that Hematopoietic Stem Cell Transplantation had the highest impact on our measurements. Conclusions: The results showed a myocardial diastolic impairment with preserved ejection fraction. Since the median follow-up time of our cohort was 2 years, further evaluation is needed to better define the diastolic alterations. TDI analysis showed high sensitivity for the detection of mild myocardial dysfunction; the implementation of this novel method as standard practice in the follow-up of selected childhood cancer survivors might help to achieve a better management of long-term complications of cardiotoxic chemotherapy.

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

“…In our group, IVRT and A wave did not change during AC treatment, in opposition to other studies [53][54][55]. E and E/A ratio decreased during therapy (p<0.001, p=0.014), suggesting a dysfunction in LV filling, similar results being encountered in different papers [54][55]. One year after diagnosis, E and E/A ratio returned to baseline values.…”

Omega 3 fatty acids can reduce early doxorubicin‐induced cardiotoxicity in children with acute lymphoblastic leukemia

“…This was in agreement with earlier studies, which found that tissue Doppler parameters, such as LV S, were sensitive to detect early doxorubicin-induced cardiotoxicity. [38][39][40][41] Interestingly, LV FS failed to show any significant decrease after doxorubicin treatment that was in line with the results of other investigators who reported that LV FS and LV ejection fraction (LV EF) were insensitive to detect early doxorubicin-induced cardiotoxicity. 38,39,42,43 Our study revealed that patients with omega 3 treatment showed nonsignificant changes in LV S and 2D-GLS, which suggested that omega 3 fatty acids protect against left ventricular dysfunction induced by doxorubicin.…”

Evaluation of Cardiotoxic Effects of Anthracyclines by Tissue Doppler Imaging in Survivors of Childhood Cancer

“… 24 Moreover, according to another study, the findings consistent with subclinical myocardial diastolic impairment could be detected by TDI, even in patients with only a follow-up period of 2 years after the completion of chemotherapy. 25 It is known that diastolic dysfunction caused by cardiomyocyte damage related with systemic disorders may often progress to heart failure, in which systolic functions are preserved. 26 , 27 In the present study, the detection of longer duration of the TDI-derived IVRT in CCSs was consistent with the subclinical impairment in left ventricular diastolic functions.…”