Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
J Am Soc Echocardiogr. 2022 Jun;35(6):629-656. doi: 10.1016/j.echo.2022.01.017. Epub 2022 Feb 8.
Children with cancer and childhood cancer survivors (CCS) are at risk for developing chemotherapy-induced cardiomyopathy. Myocardial deformation imaging has shown potential in the early detection of subclinical myocardial damage with implications on therapeutic interventions and improvement of outcomes. The aim of this study was to perform a systemic review and meta-analysis of literature on the assessment of left ventricular and right ventricular myocardial deformation by speckle-tracking echocardiography at rest and during stress in children with cancer during and in survivors after chemotherapy.
A systematic review was performed through searching MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials, and Scopus. Search hedges were created to cover the concepts of childhood cancer, chemotherapy, radiotherapy, anthracycline, cardiotoxicity, speckle-tracking, myocardial strain, and myocardial deformation. Two independent investigators reviewed the eligibility of articles for inclusion. The weighted mean difference in ventricular strain between pre- and postchemotherapy treatment and that between long-term CCS and healthy subjects were estimated using random-effect models with 95% CIs. Heterogeneity and publication bias were assessed using I statistics and the Egger test, respectively.
Of the total of 8,703 records initially identified, 42 studies with a total of 5,430 children with cancer were included. Of these 42 studies that showed heterogeneities, nine assessed early myocardial injury during chemotherapy, 30 assessed late myocardial injury after chemotherapy with no publication bias, and three studied myocardial mechanics during stress. The main findings were as follows: (1) left ventricular systolic deformation is impaired in children with cancer during the initial treatment phase and among long-term CCS, while data on changes in right ventricular deformation are limited and inconclusive; (2) the predictive value of early reduction of myocardial strain imaging in forecasting subsequent development of cardiotoxicity is unknown, as it has not been studied; (3) limited data suggest the possibility of impaired left ventricular contractile mechanics during stress in CCS; and (4) cumulative anthracycline dose and chest-directed radiotherapy are consistently identified as factors associated with impaired myocardial deformation.
Myocardial strain imaging by speckle-tracking echocardiography unveils early evidence of myocardial injury in children with cancer and long-term CCS. To support its adoption for clinical use, more data are required for the better understating of myocardial deformation parameters in the risk stratification of children with cancer and prediction of development of cardiomyopathy among CCS.
患有癌症的儿童和儿童癌症幸存者（CCS）有发生化疗诱导性心肌病的风险。心肌变形成像在检测亚临床心肌损伤方面显示出了潜力，这对治疗干预和改善结局具有重要意义。本研究的目的是对癌症患儿化疗期间和幸存者化疗后应用斑点追踪超声心动图评估左、右心室心肌变形的文献进行系统评价和荟萃分析。
通过检索 MEDLINE、Embase、护理和联合健康文献累积索引、Cochrane 对照试验中心注册库和 Scopus 进行系统评价。创建搜索词来涵盖儿童癌症、化疗、放疗、蒽环类药物、心脏毒性、斑点追踪、心肌应变和心肌变形等概念。两名独立的研究者评估了纳入研究的资格。使用随机效应模型和 95%CI 估计化疗前后心室应变的加权均数差值，以及长期 CCS 与健康受试者之间的差异。使用 I ²统计量和 Egger 检验评估异质性和发表偏倚。
在最初确定的 8703 条记录中，共有 42 项研究（共纳入 5430 名癌症患儿）符合纳入标准。这 42 项研究显示存在异质性，其中 9 项研究评估了化疗期间早期心肌损伤，30 项研究评估了化疗后晚期心肌损伤，无发表偏倚，3 项研究评估了应激时的心肌力学。主要发现如下：（1）癌症患儿在初始治疗阶段和长期 CCS 中左心室收缩变形受损，而右心室变形变化的数据有限且不一致；（2）早期心肌应变成像降低对预测随后发生心脏毒性的预测价值尚不清楚，因为尚未对此进行研究；（3）有限的数据表明 CCS 患者在应激时左心室收缩力学受损的可能性；（4）累积蒽环类药物剂量和胸部定向放疗被一致认为是与心肌变形受损相关的因素。
斑点追踪超声心动图的心肌应变成像揭示了癌症患儿和长期 CCS 存在早期心肌损伤的证据。为了支持其临床应用，需要更多数据来更好地了解癌症患儿的心肌变形参数，以及预测 CCS 患者发生心肌病的风险。
