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Left ventricular myocardial deformation and mechanical dyssynchrony in children with normal ventricular shortening fraction after anthracycline therapy
  1. Yiu-fai Cheung,
  2. Wen-jing Hong,
  3. Godfrey C F Chan,
  4. Sophia J Wong,
  5. Shau-yin Ha
  1. Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Professor Yiu-fai Cheung, Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China; xfcheung{at}hkucc.hku.hk

Abstract

Objective The M-mode-derived left ventricular shortening fraction is incorporated into most of the paediatric oncology protocols for monitoring of cardiotoxicity. This study tested the hypothesis that alteration of left ventricular myocardial deformation and mechanical dyssynchrony may occur in asymptomatic children after anthracycline therapy despite having left ventricular shortening fractions within the limits of normal.

Design Cross-sectional study.

Setting Tertiary paediatric cardiac centre.

Methods Left ventricular longitudinal, circumferential and radial myocardial deformation was determined using speckle tracking echocardiography in 45 patients aged 15.3±5.8 years. Real-time three-dimensional echocardiographic data were acquired for the measurement of left ventricular volumes and systolic dyssynchrony index (SDI), the latter derived from the dispersion of time-to-minimum regional volume using a 16-segment model. The results were compared with those of 44 controls.

Results Compared with controls, patients had reduced left ventricular global systolic longitudinal strain (p=0.012), circumferential strain (p<0.001), radial strain (p=0.006) and circumferential strain rate (SR; p=0.002). The cumulative anthracycline dose correlated negatively with global longitudinal (r=−0.33, p=0.027) and circumferential (r=−0.32, p=0.035) SR. The left ventricular SDI was significantly greater in patients than controls (4.46±1.52% vs 3.80±0.58%, p=0.03). The prevalence of left ventricular mechanical dyssynchrony (SDI >4.96%) in patients was 16% (95% CI 6% to 29%). In patients, SDI correlated negatively with left ventricular ejection fraction (r=−0.52, p<0.001), radial strain (r=−0.35, p=0.021), circumferential strain (r=−0.37, p=0.015) and circumferential SR (r=−0.43, p=0.004), but not with the cumulative anthracycline dose (p=0.82).

Conclusions Impaired left ventricular myocardial deformation and mechanical dyssynchrony may exist in children after anthracycline therapy despite having normal left ventricular shortening fractions.

  • Anthracycline cardiotoxicity
  • echocardiography paediatrics
  • paediatric cardiac function

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Footnotes

  • Funding This study is supported by the Children's Cancer Foundation and CRCG funding, the University of Hong Kong.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the institutional review board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster, Hong Kong.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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