Echocardiography detected cardiotoxicity in fewer patients than CMR (43 vs. 61), but differences were not statistically significant, supporting ECHO as a first-choice method.
Does cardiac magnetic resonance imaging improve the detection of chemotherapy-induced cardiotoxicity compared to echocardiography in children and adolescents?
CMR and echocardiography showed no statistically significant difference in detecting chemotherapy-induced cardiotoxicity or measuring ejection fraction in pediatric patients, supporting echocardiography as the preferred initial method due to accessibility and lower costs.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Chemotherapy-induced cardiotoxicity is a significant complication in the treatment of childhood cancer, which can lead to irreversible cardiac dysfunction and impact long-term quality of life. Early detection of these alterations is essential for the implementation of cardioprotective strategies. Echocardiography and myocardial magnetic resonance imaging are widely used diagnostic tools for cardiac monitoring, but they present differences in terms of sensitivity, specificity and applicability in the pediatric population. This study compares the efficacy of echocardiography and myocardial magnetic resonance imaging in the early identification of chemotherapy-induced cardiotoxicity in children and adolescents. Objectives To evaluate the efficacy to detect cardiotoxicity and ejection fraction parameters of these two imaging methods in children and adolescents undergoing chemotherapy. Methods Three databases were analyzed in February 2025: PubMed, Embase and Cochrane, searching for studies that compared the use of cardiac magnetic resonance imaging (CMR) with echocardiography (ECHO) in children and adolescents undergoing chemotherapy agents. The outcomes of interest were the occurrence of cardiotoxicity in each imaging method and the mean ejection fraction (EF) obtained in each imaging method in the patients. This systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. The software used for statistics was R version 4.3.2. Results Three prospective cross-sectional studies that met our study objective were found, including 176 children and adolescent patients, with a mean age of 11.8 years (standard deviation of 4.6) who underwent chemotherapy drugs. The class of drugs used by these patients was anthracyclines, with 107 (60.7%) being males. Leukemia was the cancer of 56 patients (31.8%). Among these patients included, 165 underwent CMR and echocardiogram, while 11 underwent only echocardiogram. Cardiotoxicity was observed in 61 patients analyzed by CMR and 43 in those who were examined by echocardiogram (RR 1.57; 95% CI 0.50-4.92; Figure 1). Regarding the mean EF outcome, the mean difference when comparing CMR to ECHO was -2.71 (95% CI −7.69 - 2.27). Finally, regarding heterogeneity, in the analysis of the outcome of the presence of cardiotoxicity, there was I²=88.9% (p=0.0001), while when analyzing the mean EF outcome, the heterogeneity of the mean difference presented was I²=95% (P 0.01). Conclusion This systematic review and meta-analysis provide evidence that the results presented did not show a statistically significant difference between the imaging methods, suggesting that due to the ease of access and lower costs associated with echocardiography, it can be used as the method of choice in these patients. In addition, the echocardiographic window in children is easier to obtain when compared to adults. Further large-scale studies are warranted to validate these findings.
Fante et al. (Sat,) reported a other. Echocardiography detected cardiotoxicity in fewer patients than CMR (43 vs. 61), but differences were not statistically significant, supporting ECHO as a first-choice method.
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