Assessment of left ventricular function in pediatric oncology by two different methods of echocardiography: a short-term outcome
DOI:
https://doi.org/10.18203/2349-3291.ijcp20220755Keywords:
Pediatric cancer, Hematological malignancies, Echocardiography, Strain imaging, GLS, Heart failureAbstract
Background: Chemotherapy-induced myocardial dysfunction (CIMD) is a documented actuate of heightened morbidity and mortality. The gold standard for the surveillance of CIMD is the serial echocardiogram. Two-dimensional speckle echocardiography i.e. global longitudinal strain (GLS) is affirmative diagnostic tool than conventional echocardiography.
Methods: We retrospectively reviewed the data of children (age between 6 months to 18 years) who received cardio-toxic chemotherapeutic agents and underwent echocardiography assessment with conventional and GLS imaging at-least 2 times between January 2020 to January 2021 in The Indus Hospital, Karachi at start, 3rd months and 6th months of treatment.
Results: We enrolled 122 patients in our study. The mean age was 8.19±4.43. 82 (67.2%) children got the 2 echocardiographic evaluations while 40 (32.8%) children completed three. Of 82 subjects, 17 (22.6%) had a significant reduction in early myocardial deformation indices as measured by two-dimensional (2D) STE using GLS at the end of 3 months of chemotherapy. Before the start of therapy, mean values of ejection fraction (EF), fractional shortening (FS) and GLS were 68.6±10.44, 38.8±7.44, and -20.7±4.19 respectively. At 3rd month and 6th month follow up, EF decreased 65.80±9.00 and 62.06±10.62 (p value 0.000) respectively while the values for GLS decreased significantly as -18.4±3.86, -16.68±3.63 (p value 0.02) respectively.
Conclusions: GLS is an effective, and non-invasive cardiac imaging modality than a conventional echocardiography in assessment of left ventricular (LV) dysfunction in non-symptomatic as well as in symptomatic children with cancers.
Metrics
References
Steliarova-Foucher E, Colombet M, Ries LAG, Moreno F, Dolya A, Bray F, et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 2017;18(6):719-31.
Bhakta N, Force LM, Allemani C, Atun R, Bray F, Coleman MP, et al. Childhood cancer burden: a review of global estimates. Lancet Oncol. 2019;20(1):42-53.
Mertens AC, Liu Q, Neglia JP, Wasilewski K, Leisenring W, Armstrong GT, et al. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J National Cancer Institute. 2008;100(19):1368-79.
Agha H, Shalaby L, Attia W, Abdelmohsen G, Aziz OA, Rahman MY. Early Ventricular Dysfunction After Anthracycline Chemotherapy in Children. Pediatric Cardiol. 2016;37(3):537-44.
Yu H, Qiu Y, Yu H, Wang Z, Xu J, Peng Y, et al. Anthracycline Induced Cardiac Disorders in Childhood Acute Lymphoblastic Leukemia: A Single-Centre, Retrospective, Observational Study. Front Pharmacol. 2021;12:598708.
Saleh Y, Abdelkarim O, Herzallah K, Abela GSJH. Anthracycline-induced cardiotoxicity: mechanisms of action, incidence, risk factors, prevention, and treatment. Heart Failure Rev. 2021;26(5):1159-73.
Bansal N, Amdani S, Lipshultz ER, Lipshultz SE. Chemotherapy-induced cardiotoxicity in children. Expert Opinion Drug Metab Toxicol. 2017;13(8):817-32.
Chow EJ, Leger KJ, Bhatt NS, Mulrooney DA, Ross CJ, Aggarwal S, et al. Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment. Cardiovasc Res. 2019;115(5):922-34.
Sofia R, Melita V, De Vita A, Ruggiero A, Romano A, Attinà G, et al. Cardiac Surveillance for Early Detection of Late Subclinical Cardiac Dysfunction in Childhood Cancer Survivors After Anthracycline Therapy. Front Oncol. 2021;11:624057.
Radu LE, Ghiorghiu I, Oprescu A, Dorobantu D, Arion C, Colita A. Cardiotoxicity evaluation in pediatric patients with acute lymphoblastic leukemia - results of prospective study. Medical Ultrasonography. 2019;21(4):449-55.
Luis SA, Chan J, Pellikka PA. Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography. Mayo Clinic Proceedings. 2019;94(1):125-38.
Laufer-Perl M, Gilon D, Kapusta L, Iakobishvili Z. The Role of Speckle Strain Echocardiography in the Diagnosis of Early Subclinical Cardiac Injury in Cancer Patients-Is There More Than Just Left Ventricle Global Longitudinal Strain? J Clin Med. 2021;10(1).
Lotti R, V DEM, Della Bona R, Porto I, Rosa GM. Speckle-tracking echocardiography: state of art and its applications. Minerva Medica. 2021.
Makavos G, Ikonomidis I, Palios J, Rigopoulos A, Katogiannis K, Parissis J, et al. Cardiac imaging in cardiotoxicity: a focus on clinical practice. Heart Failure Rev. 2021;26(5):1175-87.
Mavinkurve-Groothuis AM, Marcus KA, Pourier M, Loonen J, Feuth T, Hoogerbrugge PM, et al. Myocardial 2D strain echocardiography and cardiac biomarkers in children during and shortly after anthracycline therapy for acute lymphoblastic leukaemia (ALL): a prospective study. Eur Heart J Cardiovasc Imaging. 2013;14(6):562-9.
Tran JC, Ruble K, Loeb DM, Chen AR, Thompson WR. Automated Functional Imaging by 2D Speckle Tracking Echocardiography Reveals High Incidence of Abnormal Longitudinal Strain in a Cohort of Pediatric Oncology Patients. Pediatric Blood Cancer. 2016;63(6):1075-80.
Pradeep H, Rupesh G, Anil TJ, Geethu K, Jayakumar T, Abdul SKJIJoM, et al. Comparison of conventional and advanced echocardiographic techniques in early detection of cardiotoxicity in patients undergoing cancer chemotherapy. Ind J Med Paediatr Oncol. 2018;39(04):429-35.
Negishi K, Negishi T, Kurosawa K, Hristova K, Popescu BA, Vinereanu D, et al. Practical guidance in echocardiographic assessment of global longitudinal strain. JACC Cardiovasc Imaging. 2015;8(4):489-92.
Zhang L, Gao J, Xie M, Yin P, Liu W, Li Y, et al. Left ventricular three-dimensional global systolic strain by real-time three-dimensional speckle-tracking in children: feasibility, reproducibility, maturational changes, and normal ranges. J Am Soc Echocardiography. 2013;26(8):853-9.
Levy PT, Machefsky A, Sanchez AA, Patel MD, Rogal S, Fowler S, et al. Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis. J Am Soc Echocardiography. 2016;29(3):209-25.
Pignatelli RH, Ghazi P, Reddy SC, Thompson P, Cui Q, Castro J, et al. Abnormal Myocardial Strain Indices in Children Receiving Anthracycline Chemotherapy. Pediatric Cardiol. 2015;36(8):1610-6.
Mavinkurve-Groothuis AM, Marcus KA, Pourier M, Loonen J, Feuth T, Hoogerbrugge PM, et al. Myocardial 2D strain echocardiography and cardiac biomarkers in children during and shortly after anthracycline therapy for acute lymphoblastic leukaemia (ALL): a prospective study. Eur Heart J Cardiovasc Imaging. 2013;14(6):562-9.
Linares Ballesteros A, Sanguino Lobo R, Villada Valencia JC, Arévalo Leal O, Plazas Hernández DC, Aponte Barrios N, et al. Early-onset Cardiotoxicity assessment related to anthracycline in children with leukemia. A Prospective Study. Colombia medica (Cali, Colombia). 2021;52(1):e2034542.
Karlsen S, Dahlslett T, Grenne B, Sjøli B, Smiseth O, Edvardsen T, et al. Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovasc Ultrasound. 2019;17(1):1-12.
Akam-Venkata J, Galas J, Aggarwal S. Cardiovascular Evaluation of Children With Malignancies. Current treatment options in cardiovascular medicine. 2019;21(3):14.
Al-Biltagi M, Abd Rab Elrasoul Tolba O, El-Shanshory MR, Abd El-Aziz El-Shitany N, El-Sayed El-Hawary E. Strain echocardiography in early detection of Doxorubicin-induced left ventricular dysfunction in children with acute lymphoblastic leukemia. ISRN pediatrics. 2012;2012:870549.
Downloads
Published
How to Cite
Issue
Section
