Ardelean Andrada Mara, Olariu Ioana Cristina, Isac Raluca, Jurac Ruxandra, Stolojanu Cristiana, Murariu Mircea, Toma Ana-Olivia, Braescu Laurentiu, Mavrea Adelina, Doros Gabriela
Department of Pediatrics, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Doctoral School, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Children (Basel). 2023 Aug 30;10(9):1479. doi: 10.3390/children10091479.
Speckle tracking-echocardiography (STE) is a novel non-invasive imaging tool capable of quantifying myocardial deformation, and thus holds promise in detecting early subclinical myocardial injury. This study aimed to evaluate the correlation of STE with traditional biomarkers in predicting anthracycline-induced cardiotoxicity in the context of varying dosages and treatment protocols in pediatric hemato-oncology patients. We conducted a retrospective study involving pediatric hemato-oncology patients undergoing anthracycline-based chemotherapy. A total of 99 patients were included in the final analysis, with 82 receiving Doxorubicin, of which 58.5% were males, and 17 receiving Epirubicin, of which 70.6% were males, with a median of 10 years old. Traditional biomarkers, such as Troponin I (cTnI) and B-type natriuretic peptide (BNP), were compared with STE parameters, including the global longitudinal strain (GLS), Simpson method of discs (SMOD), and myocardial performance index (MPI). A comprehensive evaluation was conducted based on different dosages of anthracyclines and different treatment protocols, with a follow-up period of one year post-chemotherapy. It was observed that the cTnI levels in the Doxorubicin group were significantly higher (3.2 ng/mL, = 0.002) than in the Epirubicin group (2.7 ng/mL). However, BNP and NT-proBNP levels were not significantly different between the two groups ( = 0.096 and = 0.172, respectively). Regarding STE parameters, a significant negative correlation was observed between the anthracycline dose and GLS (Rho = -0.411, = 0.001), indicating increased cardiotoxicity with dose elevation. The SMOD and MPI gave significantly better values in the Epirubicin group (59.2 and 0.41 vs. 54.4 and 0.36, respectively). However, the ROC analysis did not find GLS, SMOD, or MPI to be significant independent predictors of cardiotoxicity ( > 0.05). There was also considerable variation in cardiotoxicity between the Doxorubicin and Epirubicin study groups, suggesting that the risk of cardiotoxicity is not solely determined by dose. Our study underlines the potential of STE as a sensitive tool for the early detection and prediction of anthracycline-induced cardiotoxicity in pediatric hemato-oncology patients, but only in association with the clinical findings and cardiac biomarkers. While traditional biomarkers still play a role, STE can offer a more accurate prediction of cardiac risk, potentially leading to better management and outcomes for these patients.
斑点追踪超声心动图（STE）是一种新型无创成像工具，能够量化心肌变形，因此在检测早期亚临床心肌损伤方面具有前景。本研究旨在评估在儿科血液肿瘤患者不同剂量和治疗方案的背景下，STE与传统生物标志物在预测蒽环类药物诱导的心脏毒性方面的相关性。我们进行了一项回顾性研究，纳入接受基于蒽环类药物化疗的儿科血液肿瘤患者。最终分析共纳入99例患者，其中82例接受多柔比星治疗，男性占58.5%；17例接受表柔比星治疗，男性占70.6%，中位年龄为10岁。将传统生物标志物，如肌钙蛋白I（cTnI）和B型利钠肽（BNP），与STE参数进行比较，包括整体纵向应变（GLS）、辛普森圆盘法（SMOD）和心肌性能指数（MPI）。根据蒽环类药物的不同剂量和不同治疗方案进行综合评估，化疗后随访一年。观察到多柔比星组的cTnI水平（3.2 ng/mL， = 0.002）显著高于表柔比星组（2.7 ng/mL）。然而，两组间BNP和NT-proBNP水平无显著差异（分别为 = 0.096和 = 0.172）。关于STE参数，观察到蒽环类药物剂量与GLS之间存在显著负相关（Rho = -0.411， = 0.001），表明随着剂量升高心脏毒性增加。表柔比星组的SMOD和MPI值显著更好（分别为59.2和0.41，而多柔比星组为54.4和0.36）。然而，ROC分析未发现GLS、SMOD或MPI是心脏毒性的显著独立预测因子（ > 0.05）。多柔比星组和表柔比星组的心脏毒性也存在相当大的差异，表明心脏毒性风险并非仅由剂量决定。我们的研究强调了STE作为检测和预测儿科血液肿瘤患者蒽环类药物诱导的心脏毒性的敏感工具的潜力，但仅与临床发现和心脏生物标志物相关联时有效。虽然传统生物标志物仍发挥作用，但STE可以更准确地预测心脏风险，可能为这些患者带来更好的管理和预后。
