Early detection of cardiotoxicity in pediatric and adolescent patients with cancer treated with anthracyclines in Northeastern Brazil

TL;DR

The study examines early detection of heart damage in young cancer patients using echocardiography in Brazil.

Contribution

It highlights the use of left ventricular global longitudinal strain for subclinical cardiotoxicity detection in pediatric oncology.

Findings

42.2% of patients showed reduced heart function despite normal ejection fraction.

Most cardiotoxicity cases were asymptomatic, emphasizing the need for early detection methods.

Leukemia and lymphoma patients were most affected by anthracycline-induced heart damage.

Abstract

To evaluate the early detection of cardiotoxicity using echocardiography in children and adolescents with cancer treated with anthracyclines.

This cross-sectional study was conducted in a tertiary pediatric oncology center in Northeastern Brazil between January 2018 and December 2022. Eligible participants were under 19-year-old patients with cancer treated with anthracyclines presenting left ventricular ejection fraction ≥55% (assessed using the biplane Simpson’s method) and abnormal left ventricular global longitudinal strain.

A total of 45 patients meeting the inclusion criteria were included. Among them, 19 patients (42.2%) showed reduced ejection fraction or left ventricular global longitudinal strain (or both) compared with baseline values, and 57.9% were asymptomatic. The most prevalent cancer was leukemia (55.5%), followed by lymphoma (20.0%). A total of 75.6% of participants were undergoing cancer treatment at the time of diagnosis of cardiotoxicity. An isolated left ventricular ejection fraction reduction occurred in 26.3% of patients, isolated left ventricular global longitudinal strain reduction in 47.4% of patients, and both alterations were experienced by 26.3% of patients.

Anthracycline-induced cardiotoxicity is a relevant adverse effect in cancer treatment, especially in patients with leukemia and lymphoma. Echocardiography, especially the assessment of left ventricular global longitudinal strain, plays a critical role in the early and subclinical detection of cardiotoxicity in pediatric patients.

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