Table 3.
Left ventricular echocardiographic parameters before and after therapy in children with cancer treated with anthracyclines, mitoxantrone and/or radiotherapy involving the heart
| Study | Number of participants | Parameter value before therapya | Timing of measurement after therapyb | Parameter value after therapya | P value |
|---|---|---|---|---|---|
| Fractional shortening (%) | |||||
| Agha 2016 [27] | 30 | 38.70 ± 3.93 | Acute/early | 36.00 ± 5.00 | < 0.01 |
| Al-Biltagi 2012 [28] | 25 | 40 ± 4.87 | Acute | 33.5 ± 6.58 | 0.02 |
| De Matos Neto 2006 [36] | 37 | 37.03 ± 3.66 | Acute/early | 35.26 ± 3.91 | nm |
| El Amrousy 2022 [62] | 30 | 40.7 ± 5.2 | Acute/early | 36 ± 3.8 | nm |
| El-Shitany 2012 [37] | 25 | 40 ± 4.62 | Acute/early | 33.5 ± 6.24 | < 0.05 |
| Erkus 2007 [38] | 29 | 39.6 ± 2.9 | Early | 36.6 ± 2.9 | < 0.05 |
| Hagag 2019 [42] | 40 | 35.6 ± 1.93 | Acute/early | 29.35 ± 1.63 | < 0.001 |
| 36, 32–38 | 29, 27–33 | nm | |||
| Hu 2018 (2) [44] | 131 | nm | Acute/early | Cumulative PIR dose < 100 mg/m2: 37.22 ± 3.56 | - |
| Cumulative PIR dose ≥ 100/ < 200 mg/m2: 37.37 ± 5.01 | 0.874 ‡ | ||||
| Cumulative PIR dose ≥ 200 mg/m2: 36.54 ± 4.8 | 0.002 ‡ | ||||
| Kang 2012 [46] | 123 | 41.0 ± 5.2 | Acute/early | Cumulative ANT dose 100 mg/m2: 38.6 ± 6.2 | nm |
| Cumulative ANT dose 200 mg/m2: 37.2 ± 4.8 | nm | ||||
| Cumulative ANT dose 300 mg/m2: 35.2 ± 6.0 | nm | ||||
| Cumulative ANT dose 400 mg/m2: 34.2 ± 6.5 | nm | ||||
| Cumulative ANT dose 500 mg/m2: 33.5 ± 8.0 | nm | ||||
| Kremer 2002 [13] | 38 | 40.5 ± 3.7 | Acute/early | 36.4 ± 4.6 | nm |
| Krischke 2016 [48] | 101 | 39 ± 8.1 | Early | 37.6 ± 6.6 | nm |
| Linares Ballesteros 2021 [64] | 112 | ALL SR: 34.5, 19–43 | Acute/early | ALL SR: 33.0, 31–40 | nm |
| ALL IR: 37.0, 27–46 | ALL IR: 34.1, 22–42 | nm | |||
| ALL HR: 36.0, 23–46 | ALL HR: 34.5, 25–43 | nm | |||
| AML: 37.0, 34–48 | AML: 34.0, 21–42 | nm | |||
| Mavinkurve-Groothuis 2013 [49] | 60 | 40 ± 5 | Early | 35 ± 3 | < 0.0001 |
| Oztarhan 2011 [52] | 276 | 43.19 ± 4.19 | Acute/early | Cumulative ANT dose 30-90 mg/m2: 43.19 ± 5.28 | nm |
| Cumulative ANT dose 120-180 mg/m2: 41.31 ± 7.01 | nm | ||||
| Cumulative ANT dose ≥ 210 mg/m2: 40.15 ± 6.11 | nm | ||||
| Sági 2018 | 661 | 41.4 ± 6.0 | Acute/early | 40.4 ± 6.1 | nm |
| Shaikh 2013 [59] | 110 | 36.6 ± 2.6 | Acute/early | 32.9 ± 5.0 | < 0.001 |
| Stöhr 2006 [57] | 172 | nm | Acute/early | 35.6 ± 4.9 | nm |
| Tantawy 2011 [58] | 39 | nm | Acute/early | Cumulative DOX dose 50-100 mg/m2: 41.5 ± 8.8 | - |
| Cumulative DOX dose 210–485 mg/m2: 40 ± 4 | 0.562 ‡ | ||||
| Fractional shortening (z-score) | |||||
| Asselin 2016 [29] | 264 | 0.37 | Acute/early | -1.68 | nm |
| Ejection fraction (%) | |||||
| Agha 2016 [27] | 30 | 70.60 ± 5.70 | Acute/early | 66.00 ± 7.18 | < 0.01 |
| Erkus 2007 [38] | 29 | 75.20 ± 0.90 | Early | 68.4 ± 4.8 | < 0.05 |
| Gupta 2018 [41] | 40 | 64.85 ± 4.94 | Acute/early | 56.15 ± 4.79 | nm |
| Hagag 2019 [42] | 40 | 68.25 ± 3.91 | Acute/early | 54.9 ± 5.35 | < 0.001 |
| 67, 62–74 | 53, 50–69 | nm | |||
| Hu 2018 (1) [43] | 36 | nm | Acute/early | Healthy controls: 66.6 ± 3.4 | - |
| Patients: 65.7 ± 5.1 | 0.52 § | ||||
| Hu 2018 (2) [44] | 131 | nm | Acute/early | Cumulative PIR dose < 100 mg/m2: 68.88 ± 6.79 | - |
| Cumulative PIR dose 100-200 mg/m2: 69.35 ± 2.73 | 0.689 ‡ | ||||
| Cumulative PIR dose ≥ 200 mg/m2: 65.95 ± 7.94 | 0.034 ‡ | ||||
| Kang 2012 [46] | 123 | 72.7 ± 5.9 | Acute/early | Cumulative ANT dose 100 mg/m2: 69.3 ± 7.8 | nm |
| Cumulative ANT dose 200 mg/m2: 67.7 ± 5.7 | nm | ||||
| Cumulative ANT dose 300 mg/m2: 65.8 ± 8.5 | nm | ||||
| Cumulative ANT dose 400 mg/m2: 63.7 ± 8.6 | nm | ||||
| Cumulative ANT dose 500 mg/m2: 63.0 ± 10.6 | nm | ||||
| Khairat 2019 [47] | 100 | 67.7 ± 3.62 | Acute/early | Normal RV GLS: 64.31 ± 7.31 | 0.697 ¶ |
| Decreased RV GLS: 65.75 ± 1.50 | |||||
| Linares Ballesteros 2021 [64] | 112 | ALL SR (Teichholz method): 65.5, 40–74 | Acute/early | ALL SR (Teichholz method): 63.0, 60–72 | nm |
| ALL SR (Simpson method): 60.2, 38–65 | ALL SR (Simpson method): 59.0, 55.7–67.2 | nm | |||
| ALL IR (Teichholz method): 68.5, 54–78 | ALL IR (Teichholz method): 64.5, 46–74 | nm | |||
| ALL IR (Simpson method): 62.9, 53.8–74.0 | ALL IR (Simpson method): 62.1, 48–75 | nm | |||
| ALL HR (Teichholz method): 66.0, 48–77 | ALL HR (Teichholz method): 64.5, 50–75 | nm | |||
| ALL HR (Simpson method): 63.5, 46–70 | ALL HR (Simpson method): 64.7, 53–67 | nm | |||
| AML (Teichholz method): 68.0, 64–77 | AML (Teichholz method): 63.0, 43–73 | nm | |||
| AML (Simpson method): 62.2, 55.5–74.3 | AML (Simpson method): 59.9, 41.0–64.4 | nm | |||
| Oztarhan 2011 [52] | 276 | 81.90 ± 4.13 | Acute/early | Cumulative ANT dose 30-90 mg/m2: 81.11 ± 5.51 | nm |
| Cumulative ANT dose 120-180 mg/m2: 78.48 ± 6.88 | nm | ||||
| Cumulative ANT dose ≥ 210 mg/m2: 75.97 ± 6.69 | nm | ||||
| Radu 2019 [53] | 48 | Median 63, IQR 60.5–65 | Acute/early | Median 62, IQR 60–65 | 0.833 |
| Shaikh 2013 [59] | 110 | 69.9 ± 4.3 | Acute/early | 62.6 ± 9.6 | < 0.001 |
| Tantawy 2011 [58] | 39 | nm | Acute/early | Cumulative DOX dose 50-100 mg/m2: 58.7 ± 7.3 | - |
| Cumulative DOX dose 210–485 mg/m2: 52 ± 4.4 | 0.043 ‡ | ||||
| Global longitudinal strain (%) | |||||
| Agha 2016 [27] | 30 | -21.58 ± 2.54 | Acute/early | -19.18 ± 3.59 | 0.001 |
| Al-Biltagi 2012 [28] | 25 | -18.65 ± 4.52 | Acute | -15.10 ± 2.45 | 0.04 |
| Cheung 2020 | 39 | -17.9 ± 1.6 | Acute/early | -15.4 ± 1.7 | nm |
| El Amrousy 2022 [62] | 30 | -19.8 ± 1.2 | Acute/early | -15.8 ± 1.6 | < 0.05 |
| El-Shitany 2012 [37] | 25 | -18.65 ± 2.9 | Acute/early | -15.1 ± 1.769 | < 0.05 |
| Hu 2018 (1) [43] | 36 | nm | Acute/early | Healthy controls: -22.2 ± 1.9 | - |
| Patients: -17.9 ± 1.9 | < 0.01 § | ||||
| Khairat 2019 [47] | 100 | -23.77 ± 0.93 | Acute/early | Normal RV GLS: LV GLS 23.84 ± 0.88 | 0.339 ¶ |
| Decreased RV GLS: LV GLS 23.40 ± 1.61 | |||||
| Linares Ballesteros 2021 [64] | 112 | ALL SR: -23.4, -26.6–16.8 | Acute/early | ALL SR: -23.2, -31–19 | nm |
| ALL IR: -24.4, -30–18 | ALL IR: -22.7, -28.0–17.4 | nm | |||
| ALL HR: -22.0, -30–18 | ALL HR: M -24.2,-26.3–18.2 | nm | |||
| AML: -21, -30–15 | AML: -22.6, -26.1–16.1 | nm | |||
| Mavinkurve-Groothuis 2013 [49] | 60 | -18.2 ± 3.1 | Early | -16.7 ± 5.2 | 0.5 |
| E/A ratio | |||||
| Agha 2016 [27] | 30 | 1.29 ± 0.27 | Acute/early | 1.03 ± 0.37 | < 0.01 |
| Al-Biltagi 2012 [28] | 25 | 1.60 ± 0.42 | Acute | 1.5 ± 0.37 | nm |
| El Amrousy 2022 [62] | 30 | 1.49 ± 1.4 | Acute/early | 1.45 ± 1.6 | nm |
| El-Shitany 2012 [37] | 25 | 1.904 ± 0.403 | Acute/early | 1.966 ± 0.389 | nm |
| Hagag 2019 [42] | 40 | 1.31 ± 0.16 | Acute/early | 1.28 ± 0.04 | 0.368 |
| 1.3, 1.1–1.6 | 1.3, 1–1.3 | nm | |||
| Mavinkurve-Groothuis 2013 [49] | 60 | 1.8 ± 0.6 | Early | 1.8 ± 0.6 | 0.8 |
| Oztarhan 2011 [52] | 276 | 1.34 ± 0.28 | Acute/early | Cumulative ANT dose 30-90 mg/m2: 1.23 ± 0.27 | nm |
| Cumulative ANT dose 120-180 mg/m2: 1.21 ± 0.23 | nm | ||||
| Cumulative ANT dose ≥ 210 mg/m2: 1.21 ± 0.28 | nm | ||||
| Radu 2019 [53] | 48 | Median 1.5, IQR 1.2–1.9 | Acute/early | Median 1.4, IQR 1.2–1.9 | 0.031 |
| Shaikh 2013 [59] | 110 | 1.6 ± 1.8 | Acute/early | 1.3 ± 0.33 | < 0.001 |
| Tantawy 2011 [58] | 39 | nm | Acute/early | Cumulative DOX dose 50-100 mg/m2: 1.7 ± 0.4 | - |
| Cumulative DOX dose 210–485 mg/m2: 1.7 ± 0.5 | 0.907 ‡ | ||||
| Tei index | |||||
| Agha 2016 [27] | 30 | 0.32 ± 0.06 | Acute/early | 0.36 ± 0.08 | < 0.01 |
| Ishii 2000 [45] | 65 | nm | Acute/early | Healthy controls: 0.33 ± 0.02 | - |
| Cumulative ANT dose < 200 mg/m2: 0.34 ± 0.09 | - | ||||
| Cumulative ANT dose ≥ 200 mg/m2: 0.45 ± 0.06 | < 0.05 ‡ § | ||||
| Shaikh 2013 [59] | 110 | 0.3 ± 0.05 | Acute/early | 0.4 ± 0.07 | < 0.001 |
Abbreviations ALL Acute lymphoblastic leukemia, AML Acute myeloid leukemia, ANT Anthracycline, GLS Global longitudinal strain, HR High risk, IQR Interquartile range, IR Intermediate risk, LV Left ventricle, nm Not mentioned, PIR Pirarubicin, RV Right ventricle, SR Standard risk
aunless otherwise specified, mean is provided with standard deviation (x ± y) and median with range (x, y–z)
bacute (within one week after a treatment); early (within one year after start of treatment); acute/early (acute and early not separable)
‡ P values in comparison to the lowest dose group are presented
§ P values in comparison to healthy controls are presented
¶ P values comparing subgroups with normal and decreased right ventricular global longitudinal strain are presented