title: Myocardial 2D strain echocardiography and cardiac biomarkers in children during and shortly after anthracycline therapy for acute lymphoblastic leukaemia (ALL): a prospective study.
abstract: OBJECTIVE
  The aim of this study was to investigate myocardial 2D strain echocardiography and cardiac biomarkers in the assessment of cardiac function in children with acute lymphoblastic leukaemia (ALL) during and shortly after treatment with anthracyclines.
  
  
  RESULTS
  Cardiac function of 60 children with ALL was prospectively studied with measurements of cardiac troponin T (cTnT) and N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and conventional and myocardial 2D strain echocardiography before start (T = 0), after 3 months (T = 1), and after 1 year (T = 2), and were compared with 60 healthy age-matched controls. None of the patients showed clinical signs of cardiac failure or abnormal fractional shortening. Cardiac function decreased significantly during treatment and was significantly decreased compared with normal controls. Cardiac troponin T levels were abnormal in 11% of the patients at T = 1 and were significantly related to increased time to global peak systolic longitudinal strain at T = 2 (P = 0.003). N-terminal-pro-brain natriuretic peptide levels were abnormal in 13% of patients at T = 1 and in 20% at T = 2, absolute values increased throughout treatment in 59%. Predictors for abnormal NT-pro-BNP at T = 2 were abnormal NT-pro-BNP at T = 0 and T = 1, for abnormal myocardial 2D strain parameters at T = 2 cumulative anthracycline dose and z-score of the diastolic left ventricular internal diameter at baseline.
  
  
  CONCLUSIONS
  Children with newly diagnosed ALL showed decline of systolic and diastolic function during treatment with anthracyclines using cardiac biomarkers and myocardial 2D strain echocardiography. N-terminal-pro-brain natriuretic peptide levels were not related to echocardiographic strain parameters and cTnT was not a predictor for abnormal strain at T = 2.Therefore, the combination of cardiac biomarkers and myocardial 2D strain echocardiography is important in the assessment of cardiac function of children with ALL treated with anthracyclines.
authors.affiliation: Department of Pediatric Hematology and Oncology, Radboud University Nijmegen Medical Centre, PO Box 9101, Huispost 804, 6500 HB Nijmegen, The Netherlands. a.mavinkurve@cukz.umcn.nl
authors.forename: Annelies M C
authors.initials: AM
authors.lastname: Mavinkurve-Groothuis
authors.forename: Karen A
authors.initials: KA
authors.lastname: Marcus
authors.forename: Milanthy
authors.initials: M
authors.lastname: Pourier
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Loonen
authors.forename: Ton
authors.initials: T
authors.lastname: Feuth
authors.forename: Peter M
authors.initials: PM
authors.lastname: Hoogerbrugge
authors.forename: Chris L
authors.initials: CL
authors.lastname: de Korte
authors.forename: Livia
authors.initials: L
authors.lastname: Kapusta
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000097:blood*; D010446:Peptide Fragments / Q000032:analysis / Q000097:blood*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D018570:Risk Assessment; D013318:Stroke Volume / Q000187:drug effects; D015996:Survival Rate; D016896:Treatment Outcome; D020107:Troponin T / Q000032:analysis / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced* / Q000000981:diagnostic imaging
chemical_list: D018943:Anthracyclines; D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: ALL; Anthracyclines; Cardiac biomarkers; Early-onset cardiotoxicity; Myocardial strain imaging