title: Abnormal Myocardial Strain Indices in Children Receiving Anthracycline Chemotherapy.
abstract: Anthracycline chemotherapy (AC) is associated with impaired left ventricular (LV) systolic function. LV ejection fraction (EF %) obtained by two-dimensional echocardiography is the current gold standard for detection and monitoring of LV systolic function. However, dependence on LVEF has been shown to be unreliable due to its inherent limitations. Speckle tracking echocardiography (STE) measures myocardial strain and is a sensitive method to detect LV systolic dysfunction with demonstrated utility in such detection in adult and pediatric cohort studies. Compare myocardial strain indices derived by STE with LVEF to detect ACT-induced LV systolic dysfunction. Prospective, cross-sectional measurements of LV myocardial strain indices derived from STE with LVEF. Pediatric cohort of 25 patients (pts): 17 females, eight males with a mean age 9.8 ± 5.8 years, who received anthracyclines (AC); median cumulative dose ≥150 ± 124.4 mg/m(2), range 60-450 mg/m(2) showing normal LV end-diastolic diameter (mm) and normal LVEF (≥55 %) underwent STE to obtain LV myocardial strain indices: strain and strain rate. The inter- and intraobserver variability for the strain indices was 5 %. Fifteen of 25 pts (60 %) showed abnormal global longitudinal peak systolic strain (GLPSS) and 19/25 pts (76 %) showed abnormal peak circumferential strain (PCS) compared to age-matched controls (p = 0.005). In contrast, no significant differences was observed in either indices with the dose of AC. Likewise, no significant changes in the systolic or diastolic strain rate were noted with the dose of AC (r (2) = 0.0076 for peak E, r (2) = 0.072 for peak A, p = NS). GLPSS and PCS were diminished and, however, correlated poorly with the cumulative dose of AC. These observations indicate an early onset of LV systolic dysfunction by the strain indices in pts who continue to show a normal LVEF implying presence of occult LV systolic dysfunction. These novel strain indices may assist in early detection of LV systolic dysfunction with implications for monitoring and prevention of AC-induced LV systolic dysfunction.
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital, MC-19345 C, 19th Floor West Tower, 6621 Fannin Street, Houston, TX, 77030, USA. cardop@bcm.tmc.edu.
authors.forename: Ricardo H
authors.initials: RH
authors.lastname: Pignatelli
authors.affiliation: Pediatric Hematology and Oncology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Payam
authors.initials: P
authors.lastname: Ghazi
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital, MC-19345 C, 19th Floor West Tower, 6621 Fannin Street, Houston, TX, 77030, USA.
authors.forename: S Chandra-Bose
authors.initials: SC
authors.lastname: Reddy
authors.affiliation: Pediatric Hematology and Oncology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Thompson
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital, MC-19345 C, 19th Floor West Tower, 6621 Fannin Street, Houston, TX, 77030, USA.
authors.forename: Qiqiong
authors.initials: Q
authors.lastname: Cui
authors.affiliation: Division of Pediatric Cardiology, Texas Children's Hospital, MC-19345 C, 19th Floor West Tower, 6621 Fannin Street, Houston, TX, 77030, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Castro
authors.affiliation: Pediatric Hematology and Oncology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Mehmet F
authors.initials: MF
authors.lastname: Okcu
authors.affiliation: Division of Pediatrics Cardiology, Cincinnati Children's Hospital, Cincinnati, OH, USA.
authors.forename: John Lynn
authors.initials: JL
authors.lastname: Jefferies
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects*; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D015588:Observer Variation; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects*; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000503:physiopathology*
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic
keywords: Anthracycline (AC); Anthracycline chemotherapy (ACT); Global longitudinal peak systolic (GLPSS) and peak circumferential strain (PCS); Left ventricular (LV) ejection fraction (EF %); Speckle tracking echocardiography (STE)