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Myocardial function in children after fetal chemotherapy exposure. A tissue Doppler and myocardial deformation imaging study

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Abstract

Chemotherapy and particularly anthracycline exposure are associated with acute and chronic cardiotoxicity. Few data exist on the effect of cardiac function after in utero exposure to maternal chemotherapy. Our recently published multicenter prospective study showed no significant changes in systolic function using conventional echocardiographic parameters. The purpose of this study was to further investigate whether early functional changes can be detected using tissue Doppler imaging (TDI) and two-dimensional (2D) speckle tracking echocardiography (STE). Sixty-two children (median/range age 1.7 (1–9.8) years) exposed to chemotherapy during fetal life were enrolled and compared to 62 age- and gender-matched controls. TDI velocities were measured at the basal interventricular septum (IVS) and right and left ventricular (LV) free walls. LV global longitudinal and circumferential systolic strains were derived using 2D STE. We found small but significant differences between the groups (patients versus controls) in LV fractional shortening [35 (29–46)% versus 39 (28–53)%, p < 0.001], LV ejection fraction [66 (57–79)% versus 70 (57–83)%, p < 0.001], LV posterior wall thickness z score [−0.15 (−2.32–1.81) versus −0.10 (−1.9–2.0), p < 0.001], and IVS thickness z score [−1.06 (−2.6–1.3) versus −0.5 (−2.1–1.7), p < 0.001]. No significant differences in TDI velocities or LV global strains were observed. Within the patient group, the cardiac functional parameters did not correlate to the number of cycles of anthracycline or the cumulative anthracycline dose. Children exposed to fetal chemotherapy have a lower normal fractional shortening and mildly lower left ventricular wall thickness. Tissue Doppler and strain measurements are within normal range and not statistically different from normal controls. The long-term implications of these findings will be further studied in this prospective cohort study.

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Abbreviations

2D:

Two dimensional

BSA:

Body surface area

IVS:

Interventricular septum

IVRT:

Isovolumetric relaxation time

LV:

Left ventricle

LVEDD:

Left ventricular end-diastolic diameter

RV:

Right ventricle

RVEDD:

Right ventricular end-diastolic diameter

LVPW:

Left ventricle posterior wall

FS:

Fractional shortening

EF:

Ejection fraction

STE:

Speckle tracking echocardiography

TDI:

Tissue Doppler imaging

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Acknowledgments

Frederic Amant is senior clinical researcher for the Research Foundation-Flanders (F.W.O.) This research is supported by Research Foundation-Flanders (F.W.O.) Project G. 0358.06, ‘Stichting tegen kanker Project SCIE2006-17’, Research Fund-K.U.Leuven (OT/07/053), Clinical Research Fund-UZ Gasthuisberg, and Belgian Cancer Plan, Ministry of Health NKP 29 038.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Leuven Cancer Institute, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium

    Mina Mhallem Gziri & Frédéric Amant

  2. Division of Cardiology, The Hospital for Sick Children, The University of Toronto, Toronto, ON, Canada

    Wei Hui & Luc Mertens

  3. Feto-maternal Unit, University Hospitals Leuven, Leuven, Belgium

    Kristel Van Calsteren

  4. Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    Nelleke Ottevanger & Livia Kapusta

  5. Wolfson Medical Center, Holon, Israel

    Livia Kapusta

  6. The Labatt Family Heart Center, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada

    Luc Mertens

Authors
  1. Mina Mhallem Gziri
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  2. Wei Hui
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  3. Frédéric Amant
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  4. Kristel Van Calsteren
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  5. Nelleke Ottevanger
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  6. Livia Kapusta
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  7. Luc Mertens
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Corresponding author

Correspondence to Luc Mertens.

Additional information

Mina Mhallem Gziri and Wei Hui contributed equally to this manuscript.

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Gziri, M.M., Hui, W., Amant, F. et al. Myocardial function in children after fetal chemotherapy exposure. A tissue Doppler and myocardial deformation imaging study. Eur J Pediatr 172, 163–170 (2013). https://doi.org/10.1007/s00431-012-1849-7

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  • DOI: https://doi.org/10.1007/s00431-012-1849-7

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