Automatic Border Detection Identifies Subclinical Anthracycline Cardiotoxicity in Children With Malignancy

Abstract

Background —Anthracycline drugs for cancer therapy often cause functional myocardial impairment even in relatively low doses. We investigated the left ventricular function in asymptomatic anthracycline-treated children by automatic border detection (ABD) to assess its clinical usefulness for unmasking latent anthracycline-induced myocardial damage. Methods and Results —Thirty-four children (0.7 to 17.6 years old) during or after anthracycline chemotherapy (26 to 1100 mg/m 2 ) for malignancy (Chemo group) were studied, and 40 children (2.8 to 15.6 years old) without cardiac involvement served as normal control subjects (Control group). All patients underwent complete echocardiographic examination, including M-mode, Doppler, and ABD. Conventional echocardiography disclosed no difference between groups with regard to ejection fraction and the ratio of early to late transmitral flow velocity. In marked contrast, an investigation using ABD revealed that the Chemo group appeared to have some anthracycline-induced myocardial damage. In the apical 4-chamber view, peak filling rate in the Chemo group [2.3±0.4 end-diastolic area (EDA)/s] was significantly lower than that in the Control group (3.1±0.5 EDA/s) ( P <0.0001), and time to peak filling rate in the Chemo group (106±31 ms) was clearly prolonged compared with that in the Control group (74±22 ms) ( P <0.0001). Conclusions —Echocardiographic ABD may be a sensitive and useful noninvasive approach for evaluating subclinical anthracycline cardiotoxicity.