Turkish Archives of Pediatrics
Original Article

Evaluation of Cardiotoxic Effects of Anthracyclines by Tissue Doppler Imaging in Survivors of Childhood Cancer


Department of Pediatrics, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey


Department of Pediatric Cardiology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey


Department of Pediatric Hematology and Oncology, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey

Turk Arch Pediatr 2021; 56: 492-498
DOI: 10.5152/TurkArchPediatr.2021.20233
Read: 57 Downloads: 38 Published: 01 September 2021

Background: Childhood cancer survivors (CCSs) are at risk for anthracycline-induced cardiotoxicity which tends to be more prominent long after completion of the chemotherapy. The aim of this study was to examine echocardiographic parameters of anthracycline-induced subclinical cardiotoxicity in children who had received chemotherapy.

Materials and Methods: A cross-sectional single-center study was conducted in a tertiary level university hospital in Eskisehir, Turkey. A total of 50 CCSs and 40 healthy peers were included. The CCSs were divided into 3 subgroups according to cumulative anthracycline dose (100-200 mg/m2, 201-299 mg/m2, and ≥ 300 mg/m2). Biventricular cardiac examination was performed with conventional echocardiography and tissue Doppler echocardiography imaging (TDI).

Results: The mean duration from termination of chemotherapy to echocardiographic assessment was 3.9 ± 2.2 years. The mean age of the CCSs was 11.6 ± 3.9 years. TDI-derived mitral annular isovolumetric relaxation time (IVRT) and myocardial performance index (MPI) were higher in the high-dose group of CCSs than in controls (P = .006, P = .007, P < .001, P = .0014, respectively). IVRT was also higher in patients with ≥ 300 mg/m2 cumulative dose than in those with < 200 mg/m2 (P = .007). TDI-derived mitral annular MPI and IVRT were significantly associated with cumulative anthracycline dose (r = 0.288, P = .006, r = 0.340, P = .001).

Conclusion: A cumulative anthracycline dose > 300 mg/m2 may lead to subclinical cardiotoxicity, and is therefore a potential risk factor for late onset cardiac failure. TDI-derived MPI can be a sensitive tool to reveal subtle signs of myocardial damage, which may facilitate implementation of preventive therapies for patients suspected to be at risk.

Cite this article as: Caliskan M, Kosger P, Ozdemir ZC, Ucar B, Bor O. Evaluation of cardiotoxic effects of anthracyclines by tissue doppler imaging in survivors of childhood cancer. Turk Arch Pediatr. 2021; 56(5): 492-498.

EISSN 2757-6256