Key result
Pediatric cancer patients exhibited significantly lower global longitudinal strain (-19.8 vs -23.4, P<0.001) compared to healthy controls prior to the initiation of chemotherapy.
Why the study?
The study was conducted to evaluate whether left ventricular systolic function is normal in children with cancer prior to starting chemotherapy compared with matched healthy controls using speckle tracking echocardiography.
Do pediatric cancer patients have abnormal left ventricular systolic function prior to initiation of chemotherapy compared to healthy controls?
Case-Control (n=171)
Do pediatric cancer patients have abnormal left ventricular systolic function prior to initiation of chemotherapy compared to healthy controls?
Pediatric cancer patients exhibit subclinical left ventricular systolic dysfunction, as measured by global longitudinal strain, even before the initiation of cardiotoxic chemotherapy.
Answers are grounded in this paper and cite their sources.
Pre-chemotherapy strain assessment may identify subclinical LV dysfunction in pediatric cancer; leaves open its prognostic value and monitoring role.
PURPOSE: We compared the left ventricular (LV) systolic function in children with cancer before initiation of chemotherapy with matched controls using speckle tracking echocardiography. METHODS AND RESULTS: In this retrospective study, we analyzed the echocardiograms of 89 cancer patients before the initiation of chemotherapy and 82 age- (8.4 ± 5.2 vs. 8.9 ± 3.9 years, P = .4) and gender-matched (64% vs. 67%, males, P = .4) healthy controls. Peak systolic LV longitudinal strain (LS) was significantly lower in cancer patients in apical two (-19.8 ± 3.0 vs. -23.5 ± 4.0, P < .001), three (-19.4 ± 3.2 vs. -23.4 ± 4.0, P < .001), and four-chamber views (-19.7 ± 3.4 vs. -22.5 ± 3.0, P < .001) compared to controls, as was global longitudinal strain (GLS) (-19.8 ± 2.7 vs. -23.4 ± 3.2, P < .001). The prechemotherapy group also had a higher E/e' ratio compared to controls at the septal (9.3 ± 3.9 vs. 7.9 ± 1.7, P = .005) and lateral annulus (7.9 ± 3.3 vs. 5.9 ± 1.4, P < .001) of the mitral valve. The LV ejection fraction was lower in cancer patients compared to controls (63.5 ± 4.9 vs. 66.8 ± 4.1, P < .001), although still within normal limits. There were no differences in LV myocardial performance index (0.30 ± 0.05 vs. 0.30 ± 0.09, P < .65) and shortening fraction (35.8 ± 5.2 vs. 36.1 ± 6.1, P < 0.75) between the two groups. Subgroup analysis showed no difference in LV GLS between patients with solid tumors (n = 56) and blood cancers (n = 33) (GLS -19.2 ± 2.9 vs. 19.5 ± 2.4, P > 0.05). CONCLUSION: Our data demonstrating abnormalities in LV GLS in pediatric cancer patients even prior to initiation of chemotherapy are novel and perplexing. Further longitudinal follow-up is required to assess the implications of this abnormal LV function in these patients.
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Akam‐Venkata et al. (2019) conducted a case-control in Pediatric cancer (n=171). Cancer (prechemotherapy) vs. Healthy controls was evaluated on Global longitudinal strain (GLS) (p=<.001). Pediatric cancer patients exhibited significantly lower global longitudinal strain (-19.8 vs -23.4, P<0.001) compared to healthy controls prior to the initiation of chemotherapy.
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