Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, the Netherlands.
PrincessMáxima Center of Pediatric Oncology, Utrecht,the Netherlands.
Am J Cardiol. 2020 Jul 15;127:163-168. doi: 10.1016/j.amjcard.2020.03.040. Epub 2020 Apr 7.
Anthracycline-induced cardiotoxicity can lead to clinical and subclinical heart failure. Decrease of global longitudinal strain is a predictor for heart failure. Early detection of subclinical cardiotoxicity is crucial for timely intervention and prevention of further progression. Cardiac function of 41 survivors of childhood acute lymphoblastic leukemia (ALL) was assessed. Values of cardiac troponin T, N-terminal-pro-brain natriuretic peptide, conventional and myocardial 2D strain echocardiography were measured before (T = 0), during (T = 1, cumulative dose of 120 mg/m), shortly after (T = 2) and long after anthracycline treatment (T = 3, ≥5 years after anthracycline exposure). Cardiac function of survivors at the latest follow up was compared with 70 healthy age-matched controls. None of the survivors showed clinical signs of cardiac failure at T = 3. Strain values decreased during anthracycline treatment and an ongoing reduction was seen at the latest follow-up (T = 3) with preserved cardiac function (normal ejection fraction and shortening fraction). At T = 1, a relative reduction in longitudinal strain (≥10% compared with baseline) was observed in 38% of the survivors, which increased to 54% at T=3. ALL survivors showed significantly lower conventional and myocardial 2D strain values, especially strain rate, compared with healthy age-matched controls. At T = 3, we did not find any abnormal cardiac troponin T levels. Six percent of the survivors showed abnormal N-terminal-pro-brain natriuretic peptide levels. This prospective study showed an ongoing reduction of 2D myocardial strain and strain rate, with preserved left ventricular ejection fraction (≤10% decrease compared with baseline) in asymptomatic ALL survivors at late follow-up.
蒽环类药物诱导的心脏毒性可导致临床和亚临床心力衰竭。整体纵向应变降低是心力衰竭的预测指标。早期发现亚临床心脏毒性对于及时干预和防止进一步进展至关重要。评估了 41 例儿童急性淋巴细胞白血病 (ALL) 幸存者的心脏功能。在治疗前（T=0）、治疗期间（T=1，累积剂量为 120mg/m）、治疗后不久（T=2）和蒽环类药物治疗后（T=3，蒽环类药物暴露后至少 5 年）测量了心脏肌钙蛋白 T、N 末端脑利钠肽前体、常规和心肌二维应变超声心动图的值。将幸存者在最新随访时的心脏功能与 70 名年龄匹配的健康对照进行比较。在 T=3 时，没有幸存者出现心力衰竭的临床迹象。在蒽环类药物治疗期间应变值下降，并且在最新随访时（T=3）仍在持续下降，但心脏功能保持正常（射血分数和缩短分数正常）。在 T=1 时，38%的幸存者观察到纵向应变相对降低（与基线相比降低≥10%），而在 T=3 时，这一比例增加到 54%。ALL 幸存者的常规和心肌二维应变值明显低于健康年龄匹配的对照组，尤其是应变率。在 T=3 时，我们没有发现任何异常的心脏肌钙蛋白 T 水平。6%的幸存者显示出异常的 N 末端脑利钠肽前体水平。这项前瞻性研究表明，在无症状 ALL 幸存者的晚期随访中，二维心肌应变和应变率持续下降，但左心室射血分数保持正常（与基线相比降低≤10%）。
