Early detection of doxorubicin-induced cardiotoxicity in children with hematological malignancies

ABSTRACT

This study aimed to investigate the value of conventional Doppler-echocardiography, Doppler tissue imaging [DTI], and serum cardiac troponin I [cTni] as early predictors of cardiotoxicity in children treated with doxorubicin for different hematological malignancies and to evaluate their feasibility as early screening tests in assessing the left as well as the right ventricular systolic and diastolic functions. This study included 19 clinically asymptomatic children aged 4.9 +/- 2.1 years with normal systolic function who were receiving doxorubicin chemotherapy [cumulative dose= 122.4 +/- 59.9 mg/m2] for different malignant neoplasms [16 children having acute lymphoblastic leukemia, 2 having acute myeloid leukemia and I having leukemic phase of lymphoma]. They were subjected to Doppler-echocardiographic and DTI examination of the right ventricular [RV] and left ventricular [LV] systolic and diastolic functions as well as estimation of serum levels of cTni by sandwich immunoassay after the last dose of doxorubicin during the induction-remission therapy. Another 20 healthy normal children were taken as a control group. Results showed that the LV systolic functions as well as LV and RV diastolic functions [assessed by Doppler study of mitral and tricuspid inflow, and mitral flow propagation velocity [MPW and myocardial performance index [MPI] were impaired in patients compared with controls. DTI study confirmed and disclosed such impairment in LV and RV systolic [decreased lateral mitral and tricuspid annulus systolic [Sa] velocities] and diastolic functions [decreased early diastolic tricuspid and lateral and septal mitral annulus [Ea] velocities and mitral Ea/Aa] in patients compared with controls. Serum cTni was statistically significantly increased in-patient as compared with the control group. There was a significant negative correlation between serum levels of cTni and Ea/Aa. On the other-hand, cumulative dose of doxorubicin was not correlated with either serum cTni or any systolic or diastolic cardiac functions