Quantitative Evaluation Of Early Left Ventricular Function In Children With Lymphoma After Chemotherapy With Speckle Tracking Imaging

Objective: The two-dimensional speckle tracking technique(2D-STI)was used to evaluate the changes of left heart function after chemotherapy in children with lymphoma,and aimed to provide more powerful means for clinical early detection of cardiac dysfunction caused by chemotherapy in children.Methods: From January 2019 to March 2020,23 cases of primary hospitalized children with pathologically diagnosed lymphoma were selected.Using GE vivid E9 color ultrasound diagnostic instrument equipped with a transthoracic ultrasound probe M5 S,and perform routine echocardiography and 2D-STI examination of lymphoma patients before and 24 h after the end of the 2nd,4th,6th,and 8th course of chemotherapy.Meanwhile,serum levels of creatine kinase isoenzyme(CK-MB)and hypersensitive troponin I(TnI-ultra)were detected in children.The EchoPAC 203 version software was used for offline analysis to obtain routine ultrasound parameters as well as longitudinal strain(LS)values at 18 segments of the left ventricle at the end of contraction.The mixed linear model combined with single factor analysis of variance was used to compare the parameters before and after chemotherapy.Using binary logistic regression method and ROC curve to evaluate the predictors of cancer therapeutics-related cardiac dysfunction(CTRCD)in the late chemotherapy.Results: 1.A total of 35 children with lymphoma were collected in this study,while one was excluded,and,11 were lost to follow-up.Finally 23 children were included.There was no statistically significant difference in general clinical parameters before and after chemotherapy in children with lymphoma(p>0.05).2.Conventional ultrasound parameters M-type LVEF,FS,E / A,E '/ A',biplane Simpson method LVEF,ESV,EDV,Tei index before and after chemotherapy had no statistically significant difference(p>0.05).3.There was no significant difference in serum markers CK-MB and TnI-Ultra before and after chemotherapy in children with lymphoma(p>0.05).4.The LS of children with lymphoma after the fourth course of chemotherapy was significantly lower than that before chemotherapy,the difference was statistically significant(p <0.05),and then the LS continued to decrease(p <0.05).5.The myocardial LS in the apical segment decreased the most than the basal segment and the middle segment,and the difference was statistically significant(p <0.05).6.Seven children with CTRCD,the incidence rate is about 30%.Binary Logistic regression analysis showed that the difference between GLS after the fourth chemotherapy and GLS before chemotherapy GLS can predict the subsequent CTRCD(p <0.05,OR = 5.31).According to the ROC curve,GLS is a predictor for detecting high-risk children with anthracycline-related cardiotoxicity(area under the curve 0.792).The optimal cutoff is 2.25%,and sensitivity is 65% while specificity is 100%.Conclusions: 1.Compared with conventional ultrasound parameters and serological myocardial markers,STI technique can early detect the decrease of left heart function caused by chemotherapy in children with lymphoma.2.The left ventricular apical segment LS is more vulnerable than the middle segment and the basal segment.3.?GLS can predict the early occurrence of CTRCD in children with lymphoma at the late stage of chemotherapy.