Background: Speckle tracking echocardiography (STE) is an innovative non-invasive imaging technique that can measure myocardial deformation, showing promise in identifying early subclinical myocardial damage. This study aimed to assess how STE correlates with traditional 2D echocardiographic parameters in predicting anthracycline-induced cardio-toxicity in pediatric Hodgkin Lymphoma (HL) cancer survivors.
Methods: This is a prospective study involving 116 pediatric HL survivors and 32 age- and sex-matched control cases were screened using Tissue Doppler Imaging (TDI) and 3D speckle tracking echocardiography. Data on chemotherapy cumulative doses and radiotherapy were retrieved from patient records.
Results: Chemotherapy-related cardiac dysfunction (CTRCD) was not detected using traditional 2D echocardiographic parameters for assessing left ventricular (LV) systolic function. Ejection fraction values did not significantly differ from baseline (mean 67.2 + 4.06 vs. 77.8 + 5.73 with P-value >0.05). However, a notable distinction was observed in 3D global longitudinal strain (GLS) between the study group and controls (18.4 +/- 3.12 vs. 18.8 +/- 4.41, P-value <0.05). Twenty-five out of 116 patients (21.5%) exhibited cardio-toxicity, showing over a 15% reduction in 3D GLS compared to the control mean. Additionally, LV diastolic function assessed by TDI was impaired in cases relative to controls, with significant differences in mitral E"/A' and mitral septal E/E' ratios (P <0.05), indicating higher filling pressures in the study population . Systolic dysfunction as measured by 2D EF% & 3D STE GLS showed no statistical significant difference post 4-6 cycles of chemotherapy or radiotherapy (p. value > 0.05). In contrast, Mitral E/E’ ratio showed significant correlation to cumulative chemotherapy dose( p value < 0.05).
Conclusion: Despite apparently normal LV systolic function in asymptomatic HL survivors, 3D STE, GLS values indicate impaired cardiac function in these patients. In contrast, TDI; E/E’ ratio which points to LV diastolic dysfunction which usually precedes systolic dysfunction showed significant correlation to cumulative chemotherapy dose. The aforementioned findings point to the need of regular screening of patients with HL during treatment by 3D STE, GLS is crucial for early detection of cardiac toxicity independent of treatment adjustments. Further studies are needed to explore the value of diastolic dysfunction in cancer patients.
Zeinab Salah, Mustafa Selim, Nesreen Ali, Antoine Abdelmassih, Mohammed Mosaad Soliman, Nahla M El Nabarawy, Hany Hussein, Doaa Mohamed Albeltagi, Iman Sidhom