# 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.

## Key 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.