Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.
Pediatr Cardiol. 2022 Mar;43(3):645-654. doi: 10.1007/s00246-021-02769-w. Epub 2021 Nov 17.
Anthracycline (AC) therapy is associated with left ventricular (LV) dysfunction. Left atrial (LA) size and function are used to assess LV diastolic function in heart failure in adults. Data on LA size and function following AC therapy in children is limited. We hypothesized that LA size and function will be abnormal in children following AC chemotherapy. This retrospective review included patients who received AC for pediatric cancers. Controls had normal echocardiograms performed for evaluation of chest pain, murmur, or syncope. Real-time three-dimensional echocardiography was performed to evaluate LA reservoir, conduit, and booster pump function parameters. In addition to LA volume data, LV shortening fraction, spectral and tissue Doppler variables assessing diastolic function as well as myocardial performance index was obtained. Groups with and without AC therapy were compared by student t-test and chi-square test. We evaluated 136 patients, 55 (40.4%) had received AC. There was no significant difference between the groups in LV shortening fraction, diastolic as well as global function indices. LA reservoir and conduit function parameters were significantly lower in AC group compared to controls. The booster function parameters showed variable results. It is intriguing that AC-treated children have smaller LA reservoir and abnormal booster function. We speculate that these findings may reflect early changes in LA compliance associated with AC exposure. Assessment of LA volumes and function as prognostic markers of AC-induced cardiotoxicity in children is warranted.
蒽环类药物（AC）治疗与左心室（LV）功能障碍有关。左心房（LA）大小和功能用于评估成人心力衰竭中的 LV 舒张功能。关于 AC 治疗后儿童 LA 大小和功能的数据有限。我们假设 AC 化疗后儿童的 LA 大小和功能将异常。这项回顾性研究纳入了接受 AC 治疗儿科癌症的患者。对照组因胸痛、杂音或晕厥接受正常超声心动图检查。使用实时三维超声心动图评估 LA 储备、传导和助推泵功能参数。除了 LA 容积数据外，还获得了评估舒张功能的 LV 缩短分数、频谱和组织多普勒变量以及心肌做功指数。通过学生 t 检验和卡方检验比较有和无 AC 治疗组。我们评估了 136 名患者，其中 55 名（40.4%）接受了 AC 治疗。在 LV 缩短分数、舒张和整体功能指数方面，两组之间无显著差异。与对照组相比，AC 组的 LA 储备和传导功能参数明显降低。助推功能参数的结果各不相同。有趣的是，接受 AC 治疗的儿童的 LA 储备较小，助推功能异常。我们推测这些发现可能反映了与 AC 暴露相关的 LA 顺应性的早期变化。评估 LA 容积和功能作为儿童 AC 诱导性心脏毒性的预后标志物是必要的。
