Acute Ventricular Dysfunction After Doxorubicin-Based Induction Therapy for Pediatric Acute Lymphoblastic Leukemia

Area of Science:

• Pediatric Oncology
• Cardiology
• Diagnostic Imaging

Background:

• Doxorubicin is crucial for treating childhood acute leukemia.
• Cardiotoxicity is a significant complication of doxorubicin therapy.
• Cardiac dysfunction can manifest acutely, early, or late during treatment.

Purpose of the Study:

• To assess the impact of doxorubicin on cardiac function in children with acute lymphoblastic leukemia.
• To evaluate echocardiography's utility in detecting doxorubicin-induced cardiotoxicity.
• To compare cardiac parameters before and after doxorubicin induction dose.

Main Methods:

• Twenty-eight children with acute lymphoblastic leukemia were enrolled.
• Echocardiography, including conventional and tissue Doppler imaging, was performed at baseline and 72 hours post-doxorubicin.
• Key systolic and diastolic parameters for both ventricles were analyzed.

Main Results:

• Doxorubicin induced both systolic and diastolic dysfunction in both ventricles.
• Significant decreases were observed in Tricuspid Annular Plane Systolic Excursion, Left Ventricular Fractional Shortening, and Ejection Fraction.
• Increases in Right and Left Ventricular Myocardial Performance Index and Isovolumetric Relaxation Times were noted, alongside reduced Tricuspid and Mitral E velocities and Tricuspid E/A ratios.

Conclusions:

• Doxorubicin administration leads to both systolic and diastolic cardiac dysfunction in pediatric patients.
• Echocardiography is vital for early detection of subclinical cardiotoxicity.
• Timely echocardiographic assessment facilitates prompt management to mitigate doxorubicin-induced cardiac damage.