Changes in Left Ventricular Longitudinal Strain with Anthracycline Chemotherapy in Adolescents Precede Subsequent Decreased Left Ventricular Ejection Fraction

Background: Pediatric cancer survivors who have been exposed to anthracycline (ANT) chemotherapy are an ever increasing population at risk for premature cardiac disease. Studies have shown that ANT is associated with impaired left ventricular (LV) myocardial deformation, but this has not been shown to be associated with traditional echocardiographic measures of LV systolic dysfunction. The aim of this study was to test the hypothesis that changes in LV longitudinal peak systolic strain (LPSS) would correlate with parameters of LV systolic dysfunction. Methods: This study included 19 prospectively enrolled pediatric patients receiving ANT (mean dose, 296 +/- 103 mg/m(2)) and 19 controls matched for age, gender, and body surface area. For ANT patients, echocardiography was performed at baseline, mid, and final treatment points (0, 4, and 8 months). Standard echocardiographic parameters and two-dimensional speckle tracking-derived longitudinal strain parameters were obtained and compared with baseline measurements in controls. Associations between changes in LV global LPSS and standard echocardiographic indices were explored. Results: Within the ANT group, the change in LV global LPSS showed a significant decrease compared with baseline at 4 months (8.7 +/- 0.2%, P = .033) and 8 months (9.2 +/- 0.3%, P = .015), while the percentage change in ejection fraction (EF) showed a statistically significant decrease at 8 months (4.3 +/- 0.1%, P = .044). LV global LPSS was decreased in the ANT group compared with controls at 4 months (18.1 +/- 2.5% vs 20.5 +/- 1.5%, P = .011) and 8 months (18.1 +/- 2.8%, P = .032). Segmental changes in mid and apical LV LPSS average were significantly correlated with change in EF (mid: r = -0.49, beta = -0.645, P = 0.039; apical: r = -0.48, beta = -0.4126, P = .046). Conclusions: In adolescents who receive ANT therapy, changes in two-dimensional LV global LPSS precede decreases in EF, and segmental changes in mid and apical LV LPSS suggest an increased likelihood that depressed LV EF will be observed later in follow-up. Two-dimensional speckle tracking-derived LV LPSS is potentially useful in the serial clinical monitoring of ANT cardiotoxicity. (J Am Soc Echocardiogr 2012;25:733-40.)