Longitudinal Trajectory of Left Ventricular Systolic Function in Children During Anthracycline-Based Chemotherapy Assessed by Noninvasive Myocardial Work

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-04-07 DOI:10.1111/echo.70151

Shanshan Li, Yanxiang Wu, Jingya Li, Yawen Deng, Liyuan Xu, Jiao Yang, Ruijuan Su, Ning Ma

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引用次数: 0

Abstract

Background

Noninvasive myocardial work (MW), which incorporates myocardial deformation and blood pressure, can be used to quantitatively evaluate left ventricular (LV) systolic function in children undergoing chemotherapy. However, the trajectories of MW indices (MWIs) in children during anthracycline-based chemotherapy remain unclear.

Objective

To investigate the longitudinal trajectories of MWIs during anthracycline-based chemotherapy and compare the relative changes between MWIs and conventional echocardiographic parameters.

Methods and Results

We retrospectively analyzed 441 echocardiograms from 102 children (median age, 7 years; 72 boys) with cancer who received anthracycline-based treatment. Conventional echocardiographic parameters (LV ejection fraction [LVEF] and global longitudinal strain [GLS]) and MWIs (global work index [GWI], global constructive work [GCW], global work efficiency [GWE], and global wasted work [GWW]) were obtained using GE EchoPAC software. The Mantel–Haenszel Chi-squared test revealed that GLS, GWI, GCW, and GWE all worsened during chemotherapy (all p < 0.05 for trend), with this deterioration appearing when the cumulative dose of anthracyclines reached 30–60 mg/m². However, no significant trends were observed for LVEF and GWW (both p > 0.05 for trend). The linear mixed models indicated that GLS and GWE exhibited a consistent downward trend, whereas GWI and GCW experienced a plateau phase within the cumulative anthracycline dose range of 100–250 mg/m². The relative changes in GWI and GCW were greater than those of GLS and GWE throughout chemotherapy.

Conclusion

Echocardiographic MW could provide a more sensitive assessment of anthracycline-induced cardiotoxicity (AIC) in children, allowing timely chemotherapy adjustment or cardioprotective measures to prevent cardiac dysfunction.

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通过无创心肌显像评估蒽环类药物化疗期间儿童左心室收缩功能的纵向轨迹

背景无创心肌功（MW）包括心肌变形和血压，可用于定量评估化疗儿童左室（LV）收缩功能。然而，蒽环类药物化疗期间儿童MW指数（MWIs）的变化轨迹尚不清楚。目的探讨蒽环类药物化疗期间MWIs的纵向变化轨迹，并比较MWIs与常规超声心动图参数的相对变化。方法与结果回顾性分析102例儿童441张超声心动图(中位年龄7岁；72名男孩)接受蒽环类药物治疗的癌症患者。采用GE EchoPAC软件获取常规超声心动图参数（左室射血分数[LVEF]和全局纵向应变[GLS]）和mwi（全局工作指数[GWI]、全局建设性工作[GCW]、全局工作效率[GWE]和全局浪费工作[GWW]）。Mantel-Haenszel卡方检验显示，化疗期间GLS、GWI、GCW和GWE均恶化(p <；趋势值为0.05)，当蒽环类药物的累积剂量达到30 - 60mg /m2时，出现这种恶化。然而，LVEF和GWW (p >；0.05表示趋势)。线性混合模型显示，在蒽环类药物累积剂量100 ~ 250 mg/m2范围内，GLS和GWE呈一致的下降趋势，而GWI和GCW呈平台期。化疗过程中GWI和GCW的相对变化大于GLS和GWE。结论超声心动图能更灵敏地评估儿童蒽环类药物引起的心脏毒性（AIC），及时调整化疗方案或采取心脏保护措施预防心功能障碍。

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

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.