Department of Pediatric Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045; Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China.
Department of Pediatric Cardiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
Chin Med J (Engl). 2018 Jun 20;131(12):1450-1456. doi: 10.4103/0366-6999.233950.
Cardiotoxicity is one of the most serious chronic complications of anthracyclines therapy. Assessment of the left ventricular ejection fraction (LVEF) fails to detect subtle cardiac dysfunction of left ventricular (LV). This study aimed to detect and evaluate new parameters of subclinical anthracyclines' cardiotoxicity in children with solid tumor.
A detailed echocardiographic examination was performed in 36 children with hepatoblastoma or rhabdomyosarcoma after receiving anthracyclines' chemotherapy and 36 healthy controls from January 2015 to December 2016. The LVEF, ratio of early diastolic peak velocity of transmitral flow (E) and septal diastolic e' mitral annular peak velocity (e'), tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were evaluated using M-mode, tissue Doppler imaging (TDI), and two-dimensional speckle tracking echocardiography (2D-STE), respectively. Echocardiographic parameters were compared between patient group and healthy controls. All patients were divided into two subgroups based on their anthracyclines' cumulative dosage (<300 mg/m subgroup and ≥300 mg/m subgroup).
All patients had no presentation of heart failure and LVEF within normal range (65.7 ± 5.1%). Compared with healthy controls, the mean E/e' increased significantly (7.9 ± 0.7 vs. 10.2 ± 3.5, t = 3.72, P < 0.01), mean TAPSE decreased significantly (17.2 ± 1.3 mm vs. 14.2 ± 3.0 mm, t = -4.03, P < 0.01), and mean LV GLS decreased significantly (-22.2% ± 1.9% vs. -17.9% ± 2.9%, t = -5.58, P < 0.01) in patient group. Compared with subgroup with anthracyclines' cumulative dosage < 300 mg/m, mean LV GLS decreased significantly (-18.7 ± 2.7% vs. -16.5 ± 2.1%, t = 2.15, P = 0.04), the mean E/e' increased significantly (9.1 ± 1.5 vs. 11.5 ± 4.9, t = -2.17, P = 0.04), and mean TAPSE decreased significantly (14.2 ± 2.1 mm vs. 12.5 ± 2.2 mm, t = -2.82, P = 0.02) in subgroup with anthracyclines' cumulative dosage ≥300 mg/m.
LV GLS is helpful in the early detection of subclinical LV dysfunction using 2D-STE. E/e' and TAPSE are other sensitive parameters in detecting subclinical cardiac dysfunction of both ventricles by TDI. These parameters show significant change with different anthracyclines' cumulative dosage, so cumulative dosage should be controlled in clinical treatment.
心脏毒性是蒽环类药物治疗最严重的慢性并发症之一。左心室射血分数（LVEF）的评估未能检测到左心室（LV）的细微心脏功能障碍。本研究旨在检测和评估儿童实体瘤中蒽环类药物心脏毒性的新参数。
2015 年 1 月至 2016 年 12 月，对 36 例接受蒽环类药物化疗的肝母细胞瘤或横纹肌肉瘤患儿和 36 例健康对照者进行了详细的超声心动图检查。使用 M 模式、组织多普勒成像（TDI）和二维斑点追踪超声心动图（2D-STE）分别评估 LVEF、二尖瓣前向血流 E 峰与室间隔舒张 E' 峰的比值（E/e'）、三尖瓣环平面收缩期位移（TAPSE）和 LV 整体纵向应变（GLS）。比较患者组和健康对照组的超声心动图参数。根据蒽环类药物累积剂量（<300 mg/m 亚组和≥300 mg/m 亚组）将所有患者分为两组。
所有患者均无心力衰竭表现且 LVEF 正常（65.7±5.1%）。与健康对照组相比，患者组的平均 E/e'显著增加（7.9±0.7 比 10.2±3.5，t=3.72，P<0.01），平均 TAPSE 显著降低（17.2±1.3 mm 比 14.2±3.0 mm，t=-4.03，P<0.01），平均 LV GLS 显著降低（-22.2%±1.9%比-17.9%±2.9%，t=-5.58，P<0.01）。与蒽环类药物累积剂量<300 mg/m 的亚组相比，蒽环类药物累积剂量≥300 mg/m 的亚组的平均 LV GLS 显著降低（-18.7±2.7%比-16.5±2.1%，t=2.15，P=0.04），平均 E/e'显著增加（9.1±1.5 比 11.5±4.9，t=-2.17，P=0.04），平均 TAPSE 显著降低（14.2±2.1 mm 比 12.5±2.2 mm，t=-2.82，P=0.02）。
二维斑点追踪超声心动图有助于检测 LV 功能障碍。TDI 中的 E/e'和 TAPSE 是检测左右心室亚临床心脏功能障碍的其他敏感参数。这些参数与不同的蒽环类药物累积剂量有显著变化，因此在临床治疗中应控制累积剂量。
