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Left ventricular strain and strain rates are decreased in children with normal fractional shortening after exposure to anthracycline chemotherapy

Published online by Cambridge University Press:  18 September 2013

Thomas J. Moon ,
Shelley D. Miyamoto ,
Adel K. Younoszai  and
Bruce F. Landeck
Thomas J. Moon
Affiliation:
Department of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado-Denver, Colorado, United States of America
Shelley D. Miyamoto
Affiliation:
Department of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado-Denver, Colorado, United States of America
Adel K. Younoszai
Affiliation:
Department of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado-Denver, Colorado, United States of America
Bruce F. Landeck*
Affiliation:
Department of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado-Denver, Colorado, United States of America
*
Correspondence to: B. Landeck, MD, Department of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado-Denver, 13123 East 16th Avenue, Aurora, Colorado, United States of America. Tel: 720-777-2943; Fax: 720-777-7290; E-mail: [email protected]
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Abstract

Background

Anthracycline chemotherapeutic agents carry the well-recognised risk of cardiotoxicity. Previous methods to evaluate cardiac function are useful, but have significant limitations. We sought to determine the left ventricular strain and strain rate of paediatric cancer patients with normal fractional shortening treated with anthracyclines using the latest ultrasound feature-tracking technology.

Patients and methods

Echocardiograms on cancer patients before anthracycline exposure and following completion of treatment were retrospectively analysed using Velocity Vector Imaging software in the circumferential and longitudinal planes. The same analysis was performed on matched controls. Only patients with a fractional shortening ≥28% were included.

Results

In all, 71 patients were identified with an age at diagnosis of 10.5 ± 4.7 years. The time from diagnosis to follow-up was 3.9 ± 4.0 years and the cumulative anthracycline dose was 356 ± 106 mg/m2. Following anthracycline exposure, paediatric cancer patients had a higher heart rate and a lower longitudinal strain, longitudinal diastolic strain rate, circumferential strain, and circumferential systolic and diastolic strain rate when compared with controls. Diastolic strain rate showed the greatest percent difference following anthracycline exposure versus controls.

Conclusion

Despite having a normal fractional shortening, children exposed to anthracyclines have subclinical derangement of their left ventricular deformation as measured by decreases in strain and strain rate in both the circumferential and longitudinal axis. In particular, there was a profound decrease in diastolic strain rate following anthracycline exposure compared with controls. Whether the decline of strain or strain rate can predict future risk of developing cardiomyopathy requires further investigation.

Keywords

EchocardiographyVelocity Vector Imaginganthracyclineleft ventricular functionpaediatric
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 5 , October 2014 , pp. 854 - 865
Copyright
Copyright © Cambridge University Press 2013 

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