Pediatric malignancies: Is the prechemotherapy left ventricular function normal?

Purpose: We compared the left ventricular (LV) systolic function in children with cancer before initiation of chemotherapy with matched controls using speckle tracking echocardiography. Methods and results: In this retrospective study, we analyzed the echocardiograms of 89 cancer patients before the initiation of chemotherapy and 82 age- (8.4 ± 5.2 vs. 8.9 ± 3.9 years, P =.4) and gender-matched (64% vs. 67%, males, P =.4) healthy controls. Peak systolic LV longitudinal strain (LS) was significantly lower in cancer patients in apical two (−19.8 ± 3.0 vs. −23.5 ± 4.0, P <.001), three (−19.4 ± 3.2 vs. −23.4 ± 4.0, P <.001), and four-chamber views (−19.7 ± 3.4 vs. −22.5 ± 3.0, P <.001) compared to controls, as was global longitudinal strain (GLS) (−19.8 ± 2.7 vs. −23.4 ± 3.2, P <.001). The prechemotherapy group also had a higher E/e' ratio compared to controls at the septal (9.3 ± 3.9 vs. 7.9 ± 1.7, P =.005) and lateral annulus (7.9 ± 3.3 vs. 5.9 ± 1.4, P <.001) of the mitral valve. The LV ejection fraction was lower in cancer patients compared to controls (63.5 ± 4.9 vs. 66.8 ± 4.1, P <.001), although still within normal limits. There were no differences in LV myocardial performance index (0.30 ± 0.05 vs. 0.30 ± 0.09, P <.65) and shortening fraction (35.8 ± 5.2 vs. 36.1 ± 6.1, P < 0.75) between the two groups. Subgroup analysis showed no difference in LV GLS between patients with solid tumors (n = 56) and blood cancers (n = 33) (GLS −19.2 ± 2.9 vs. 19.5 ± 2.4, P > 0.05). Conclusion: Our data demonstrating abnormalities in LV GLS in pediatric cancer patients even prior to initiation of chemotherapy are novel and perplexing. Further longitudinal follow-up is required to assess the implications of this abnormal LV function in these patients.