Permanent longitudinal strain damage of cardiotoxic drugs in childhood cancer: What is the safe level?

IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Annals of Pediatric Cardiology Pub Date : 2024-01-01 Epub Date: 2024-05-24 DOI:10.4103/apc.apc_146_23
Hamid Mohammadi, Hossein Hosseini, Mohammadreza Bordbar, Nima Mehdizadegan, Hamid Amoozgar, Mohammad Reza Edraki, Amir Naghshzan, Nima Naderi, Elham Abedi, Kambiz Keshavarz
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引用次数: 0

Abstract

Objective: Anthracycline administration in children is associated with cardiac dysfunction. Speckle-tracking echocardiography (STE) can detect subclinical cardiac damage that may go undetected by conventional two-dimensional (2D) echocardiography. This study aims to investigate medium-term anthracycline cardiotoxicity using STE and determine a safer administrable level of anthracyclines (ACs).

Methods: This observational case-control study enrolled 37 healthy controls and 78 pediatric cancer survivors who received chemotherapy. The patients were divided into two groups: cardiotoxic received (CR) and cardiotoxic free (CF). Data on segmental longitudinal strain (LS), global LS (GLS), and 2D echocardiographic parameters were collected after a drug-free period of at least one year.

Results: A total of 115 children with a mean age of 108 ± 55 months, of whom 66% were males, were included in the study. Both the groups of cancer survivors exhibited significantly reduced GLS compared to healthy controls (CR vs. controls, P = 0.001; CF vs. controls, P = 0.013), but no significant difference in left ventricular ejection fraction (LVEF) was observed (P = 0.75). Overall, cancer survivors treated with ACs demonstrated a significant reduction in strain in 10 left ventricular segments, particularly in the basal segments (P < 0.05). Among CR patients, those with impaired GLS (n = 43, GLS worse than -21.9) had significantly higher mean age and cumulative anthracycline dose compared to CR patients with normal GLS (age, P = 0.024; anthracycline dosage, P = 0.036). Using an anthracycline cutoff of 223 mg/m2 resulted in a higher detection rate (49% vs. 25%) and fewer missed cases (51% vs. 74%) compared to the 360 mg/m2 anthracycline cutoff.

Conclusion: Childhood cancer survivors demonstrate significantly reduced GLS while preserving a normal LVEF, which does not differ significantly from reference values of healthy children. The reduction in strain appears to be associated with higher anthracycline doses and older age. Lowering the anthracycline threshold to 223 mg/m2 may improve the predictability of a decline in cardiac function using strain imaging at medium-term follow-up.

儿童癌症患者心脏毒性药物的永久性纵向应变损伤:安全水平是多少?
目的儿童服用蒽环类药物会导致心脏功能障碍。斑点追踪超声心动图(STE)可检测出传统二维(2D)超声心动图可能检测不到的亚临床心脏损伤。本研究旨在利用 STE 调查蒽环类药物的中期心脏毒性,并确定更安全的蒽环类药物(ACs)用药剂量:这项观察性病例对照研究招募了 37 名健康对照者和 78 名接受过化疗的儿童癌症幸存者。患者被分为两组:接受心脏毒性治疗组(CR)和无心脏毒性治疗组(CF)。在至少一年的无药期后,收集有关节段纵向应变(LS)、整体LS(GLS)和二维超声心动图参数的数据:研究共纳入 115 名儿童,平均年龄为 108 ± 55 个月,其中 66% 为男性。与健康对照组相比,两组癌症幸存者的GLS均明显降低(CR与对照组相比,P = 0.001;CF与对照组相比,P = 0.013),但左心室射血分数(LVEF)无明显差异(P = 0.75)。总体而言,接受 ACs 治疗的癌症幸存者 10 个左心室节段的应变明显减少,尤其是基底节段(P < 0.05)。在 CR 患者中,与 GLS 正常的 CR 患者相比,GLS 受损的患者(n = 43,GLS 差于-21.9)的平均年龄和蒽环类药物累积剂量明显更高(年龄,P = 0.024;蒽环类药物剂量,P = 0.036)。与 360 毫克/平方米的蒽环类药物临界值相比,使用 223 毫克/平方米的蒽环类药物临界值可提高检出率(49% 对 25%),减少漏检病例(51% 对 74%):结论:儿童癌症幸存者在保持正常 LVEF 的同时,GLS 明显降低,与健康儿童的参考值差异不大。应变的减少似乎与蒽环类药物剂量增加和年龄增大有关。将蒽环类药物的阈值降低到223毫克/平方米可能会提高中期随访时使用应变成像预测心功能下降的能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Pediatric Cardiology
Annals of Pediatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.40
自引率
14.30%
发文量
51
审稿时长
23 weeks
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