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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 12  |  Page : 1450-1456

Detection of Subclinical Anthracyclines' Cardiotoxicity in Children with Solid Tumor


1 Department of Pediatric Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045; Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
2 Department of Pediatric Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
3 Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China

Correspondence Address:
Prof. Zhong-Dong Du
Department of Pediatric Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.233950

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Background: Cardiotoxicity is one of the most serious chronic complications of anthracyclines therapy. Assessment of the left ventricular ejection fraction (LVEF) fails to detect subtle cardiac dysfunction of left ventricular (LV). This study aimed to detect and evaluate new parameters of subclinical anthracyclines' cardiotoxicity in children with solid tumor. Methods: A detailed echocardiographic examination was performed in 36 children with hepatoblastoma or rhabdomyosarcoma after receiving anthracyclines' chemotherapy and 36 healthy controls from January 2015 to December 2016. The LVEF, ratio of early diastolic peak velocity of transmitral flow (E) and septal diastolic e' mitral annular peak velocity (e'), tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were evaluated using M-mode, tissue Doppler imaging (TDI), and two-dimensional speckle tracking echocardiography (2D-STE), respectively. Echocardiographic parameters were compared between patient group and healthy controls. All patients were divided into two subgroups based on their anthracyclines' cumulative dosage (<300 mg/m2 subgroup and ≥300 mg/m2 subgroup). Results: All patients had no presentation of heart failure and LVEF within normal range (65.7 ± 5.1%). Compared with healthy controls, the mean E/e' increased significantly (7.9 ± 0.7 vs. 10.2 ± 3.5, t = 3.72, P < 0.01), mean TAPSE decreased significantly (17.2 ± 1.3 mm vs. 14.2 ± 3.0 mm, t = −4.03, P < 0.01), and mean LV GLS decreased significantly (−22.2% ± 1.9% vs. −17.9% ± 2.9%, t = -5.58, P < 0.01) in patient group. Compared with subgroup with anthracyclines' cumulative dosage < 300 mg/m2, mean LV GLS decreased significantly (−18.7 ± 2.7% vs. −16.5 ± 2.1%, t = 2.15, P = 0.04), the mean E/e' increased significantly (9.1 ± 1.5 vs. 11.5 ± 4.9, t = −2.17, P = 0.04), and mean TAPSE decreased significantly (14.2 ± 2.1 mm vs. 12.5 ± 2.2 mm, t = −2.82, P = 0.02) in subgroup with anthracyclines' cumulative dosage ≥300 mg/m2. Conclusions: LV GLS is helpful in the early detection of subclinical LV dysfunction using 2D-STE. E/e' and TAPSE are other sensitive parameters in detecting subclinical cardiac dysfunction of both ventricles by TDI. These parameters show significant change with different anthracyclines' cumulative dosage, so cumulative dosage should be controlled in clinical treatment.

 

 Abstract in Chinese

儿童实体瘤蒽环类药物的亚临床心脏毒性分析

摘要

背景:心脏毒性是蒽环类药物最常见的慢性并发症,左室射血分数(LVEF)不能发现左心室功能的微小异常。本研究目的是发现能检测和评价儿童实体肿瘤应用蒽环类药物所致亚临床心脏毒性的新参数。

方法:收集自2015年1月至2016年12月,36例接受蒽环类药物化疗的肝母细胞瘤(HB)或横纹肌肉瘤(RMS)患儿和36例健康对照儿童,采用M型、组织多普勒成像(TDI)和二维斑点追踪超声心动图(2D-STE),分别详细测量以下参数:左室射血分数(LVEF)、舒张早期二尖瓣E峰流速(E)和室间隔舒张期二尖瓣环峰值速度(eSQ)的比值、三尖瓣环收缩期位移(TAPSE)和左心室整体纵向应变(GLS)。应用统计学方法比较患者组和健康对照组的超声心动图参数。并依据蒽环类药物累积剂量将患者分为<300mg/m2和≧300mg/m2两个亚组。

结果:所有患儿均无心衰临床表现,LVEF均在正常范围内(65.7±5.1%)。与健康对照组比较,患者组平均E/eSQ显著性升高(7.9±0.7 vs. 10.2±3.5, t=3.72, P<0.01);平均TAPSE显著性降低(17.2±1.3 mm vs. 14.2±3.0 mm, t=-4.03, P<0.01);平均左心室GLS显著性下降(-22.2±1.9% vs. -17.9±2.9%, t=-5.58, P<0.01)。与蒽环类药物累积剂量<300 mg/m2亚组比较,累积剂量≥300mg/m2亚组的平均左心室GLS显著性下降(-18.7±2.7% vs. -16.5±2.1%, t=2.15, P=0.04);平均E/eSQ显著性升高(9.1±1.5 vs. 11.5±4.9, t=−2.17 P=0.04), 平均TAPSE显著性下降(14.2±2.1 mm vs. 12.5±2.2 mm, t=−2.82, P=0.02)。

结论:通过2D-STE测量的左心GLS在早期监测亚临床左心室功能不全有价值;通过TDI测量的E/eSQ和TAPSE是其他能监测双心室亚临床功能不全的敏感指标;这些参数随蒽环类药物的累积剂量发生显著性改变,临床治疗中需控制累积剂量。



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