Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 30;10(9):1479.
doi: 10.3390/children10091479.

Correlation of Speckle-Tracking Echocardiography with Traditional Biomarkers in Predicting Cardiotoxicity among Pediatric Hemato-Oncology Patients: A Comprehensive Evaluation of Anthracycline Dosages and Treatment Protocols

Andrada Mara Ardelean  1   2   3 , Ioana Cristina Olariu  1   3 , Raluca Isac  1   3 , Ruxandra Jurac  1   3 , Cristiana Stolojanu  2   3 , Mircea Murariu  2   3 , Ana-Olivia Toma  4 , Laurentiu Braescu  2   5   6 , Adelina Mavrea  7 , Gabriela Doros  1   3
Affiliations

Correlation of Speckle-Tracking Echocardiography with Traditional Biomarkers in Predicting Cardiotoxicity among Pediatric Hemato-Oncology Patients: A Comprehensive Evaluation of Anthracycline Dosages and Treatment Protocols

Andrada Mara Ardelean et al. Children (Basel). .

Abstract

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, p = 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 (p = 0.096 and p = 0.172, respectively). Regarding STE parameters, a significant negative correlation was observed between the anthracycline dose and GLS (Rho = -0.411, p = 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 (p > 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.

Keywords: cardiotoxicity; echocardiography; hematology; oncology; pediatrics.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient flowchart.
Figure 2
Figure 2
Kaplan–Meier analysis of cardiotoxicity risk by treatment type.
Figure 3
Figure 3
Correlation analysis of factors associated with cardiac toxicity.
Figure 4
Figure 4
ROC analysis.
See this image and copyright information in PMC

References

    1. O’Leary M., Krailo M., Anderson J.R., Reaman G.H., Children’s Oncology Group Progress in childhood cancer: 50 years of research collaboration, a report from the Children’s Oncology Group. Semin. Oncol. 2008;35:484–493. doi: 10.1053/j.seminoncol.2008.07.008. - DOI - PMC - PubMed
    1. Avila M.S., Siqueira S.R.R., Ferreira S.M.A., Bocchi E.A. Prevention and Treatment of Chemotherapy-Induced Cardiotoxicity. Methodist Debakey Cardiovasc. J. 2019;15:267–273. doi: 10.14797/mdcj-15-4-267. - DOI - PMC - PubMed
    1. Mudd T.W., Jr., Khalid M., Guddati A.K. Cardiotoxicity of chemotherapy and targeted agents. Am. J. Cancer Res. 2021;11:1132–1147. - PMC - PubMed
    1. Tripaydonis A., Conyers R., Elliott D.A. Pediatric Anthracycline-Induced Cardiotoxicity: Mechanisms, Pharmacogenomics, and Pluripotent Stem-Cell Modeling. Clin. Pharmacol. Ther. 2019;105:614–624. doi: 10.1002/cpt.1311. - DOI - PMC - PubMed
    1. Kibudde S., Mondo C.K., Kibirige D., Walusansa V., Orem J. Anthracycline induced cardiotoxicity in adult cancer patients: A prospective cohort study from a specialized oncology treatment centre in Uganda. Afr. Health Sci. 2019;19:1647–1656. doi: 10.4314/ahs.v19i1.40. - DOI - PMC - PubMed