The Study Of Appreciating Cardiac Function By Echocardiography After Antharcycline Therapy For Malignant Disease In Children

Objective: We analysised anthracycline-related cardiotoxicity in different cumulative dose,studied cardiotoxicity by echocardiography,monitored an early change of cardiac function,and made a conclusion which parameters were more sensitive.At the same time,we studied the relationship between these parameters and dose to analysis the change due to it.All we did is to provide more auxiliary information for clinical and make further improvement on children's life quality and survival rate.Methods: Thirty-four children [aged 2–14 years;mean ± SD 7.9±3.5years,16 females and 18 males] who were suffering from malignant tumor and hospitalized in the Fourth Affiliated Hospital of Hebei Medical University between June 2015 to December 2016 were evaluated clinical cardiotoxicity.The patients comprised 10 with ALL,3 with AML,2 with HL,9 with NHL,2with rhabdomyosarcoma,4 with neurobiastoma,and 4 with other malignant tumors.All cases with programmed cure were corresponding to diagnosis standards or had a diagnosis confirmed histopathologically.Excluded the following diseases,congenital heart diseases(ASD,VSD,PDA,TOF etc.),hypertension,arrhythmia,myocarditis,cardiomyopathy,genetic and metabolic diseases,and trisomy 21-Syndrome,and were without the chest radiotherapy.We also collected 17 children [aged 2–13 years;mean ± SD 7.2±3.4 years,9females and 8 males] as the control group.We assessed cardiac injury with echocardiography before the first cure,at cumulative doses of anthracycline100,200 and 250mg/m2.We collected the 34 cases of sex,age,height,weight,surface area and other clinical datas.So did the children in the control group.The conventional parameters included LVEF,LVFS,SV,HR,CO,EDV,ESV;EM,AM,EM/AM;and ET,AT,ET/AT.Tissue doppler parameters and Tei index related parameters included e'M,a'M,e'M/a'M,s' M;e'T,a'T,e'T/a'T,s' T;EM/e'M,ET/e'T;ICTLL,IRTLL,ETLL,TeiLL;ICTS,IRTS,ETS,TeiS;ICTRL,IRTRL,ETRL,Tei RL;and TeiM,TeiT.Results: Compared to control group,there were no significant differences in the basic clinical datas,conventional ultrasonic parameters,tissue doppler parameters and Tei index related indicators in the case group.And there were no significant differences in conventional ultrasonic indicators before the first cure,at cumulative doses of anthracycline 100,200 and 250mg/m2,P>0.05.In tissue doppler parameters and Tei index related parameters,e'M/a'M decreased,ICTLL,TeiLL,TeiS,ICTRL,TeiRL,TeiM and TeiT increasd,P<0.05.Dose were positively correlated with ICTLL,ICTRL,TeiLL,Tei RL,TeiM and TeiT,and presented little relationships to e'M/a'M and Tei S.TeiM and TeiT increased with the drug cumulative doses,and the linear regression equation could be demonstrated(?) =0.00012X+0.364,(?) =0.00013X+0.368,P<0.01.Conclusions:Compared to control group,the indicators were normal before taking this drug.After the drug was administered,anthracycline drugs induced heart injury before clinical symptom appeared.It showed that the change of tissue doppler parameters and Tei index appeared earlier than conventional parameters.The prolongation of ICTLL and ICTRL led to the extension of regional contraction time.As a result of ventricular myocardial asynchronous contraction,cardiac function was damaged.At the same time,e'M/ a'M which represented diastolic function and measured by tissue doppler showed abnormal when conventional echocardiography parameters E/A was normal.Due to the abnormality of delicate systolic function and early diastolic function,Tei index which represented the global function displayed incorrectly,such as TeiLL,Tei S,TeiRL,TeiM and TeiT.Tei index,which was worked out by considering the contraction and relaxation time together,are relatively easy to measure.In addition to this,it would not be affected by heart rate,blood pressure,cardiac stress and the heart shape.According to the analysis of correlation and regression,Tei index increased with the increase of drug cumulative dose.In consequence,Tei index representing the global function and e'M/ a'M representing diastolicfunction can be applied to monitor the early change of cardiac function of children who took antharcycline.