Early Ventricular Dysfunction After Anthracycline Chemotherapy in Children

The aim of this study was to determine the effect of induction dose of anthracycline chemotherapy on the biventricular function among children with acute hematological malignancies (AHM) using tissue Doppler imaging (TDI) and 2D speckle tracking echocardiography (2D-STE). Thirty pediatric patients with AHM and a mean age of 9.24 +/- A 4.14 years performed conventional echocardiography, TDI and 2D-STE. After induction chemotherapy, the RV showed mainly a diastolic alteration in its function manifested in significant reduction in the tricuspid TDI-derived E' and E'/A' ratio compared with the baseline (20.40 +/- A 3.81 vs. 17.47 +/- A 3.87 cm/s, p = 0.001, 1.29 +/- A 0.27 vs. 1.03 +/- A 0.37, p < 0.01, respectively), while the TDI-derived RV MPI and isovolumetric relaxation time of RV were significantly increased (0.32 +/- A 0.06 vs. 0.36 +/- A 0.08, p < 0.01, 24.73 +/- A 8.62 vs. 28.47 +/- A 11.51 ms, p < 0.05, respectively). The LV showed post-chemotherapy mainly an alteration in its longitudinal systolic function in the form of a reduction in MAPSE (13.61 +/- A 2.00 vs. 11.95 +/- A 1.75 mm; p < 0.001), TDI-derived systolic velocity of lateral mitral annulus (10.98 +/- A 2.34 vs. 10.03 +/- A 1.83 cm/s, p < 0.05), 2D-STE-derived global longitudinal strain (-21.58 +/- A 2.54 vs. -19.18 +/- A 3.59 %, p = 0.001) and 2D-STE-derived global longitudinal strain rate (-1.76 +/- A 0.22 vs. 1.55 +/- A 0.29 1/s, p < 0.05), with preservation of LV diastolic function when compared to baseline. TDI and 2D-STE could be used for early detection of anthracycline-induced cardiotoxicity in the pediatric age group. Early after induction chemotherapy, the RV develops mainly diastolic dysfunction, while the LV showed a relative longitudinal systolic impairment.