ABSTRACT
Current mortality is low in cases of childhood acute leukemia. Dilated cardiomyopathy induced by anthracyclines remains the main cause of morbidity and mortality during mid-term and long-term follow-up. The aim of our study was to analyze the profile of left ventricular alterations in children treated with anthracyclines and to analyze risks and protective factors, including physical activity. Children and young adults with acute leukemia treated with anthracyclines between 2000 and 2018 during childhood were included. The physical activity performed by the patients before and after treatment was quantified in metabolic equivalent tasks, MET.h, per week. An echocardiographic assessment was performed, including strain analysis. Thirty-eight patients with a median age of 5 [3-8] years were included. Dilated cardiomyopathy was diagnosed in 3 patients and longitudinal strain abnormalities were observed in 11 patients (28.9%). Radiotherapy, cumulative anthracycline doses > 240 mg/m2, and the practice of physical activity > 14 MET.h per week (after leukemia treatment) were independently associated with strain abnormalities. In multivariate analysis, radiotherapy was significantly associated with an increased risk of LV GLS abnormalities (OR = 1.26 [1.01-1.57], p = 0.036), and physical activity > 14 MET.h/week after oncological treatment was significantly associated with a reduction in the risk of LV GLS abnormalities (OR of 0.03 [0.002-0.411], p = 0.009). The strain assessment of left ventricular function is an interesting tool for patient follow-up after leukemia treatment. Moderate and steady physical activity seems to be associated with fewer longitudinal strain abnormalities in patients treated with anthracyclines during childhood.
ABSTRACT
BACKGROUND: Doppler echocardiographic methods, such as the proximal isovelocity surface area (PISA) method, are used to quantify mitral regurgitations (MRs). However, their accuracy and reproducibility are still being discussed, especially in the case of MR of complex geometry. The aim of this study was to evaluate the accuracy of the PISA method depending on the shape and number of regurgitant flows. METHODS: First, various MR shapes and severities (central, oblong, and multiple-jet MR) were mimicked in a left heart simulator. The effective regurgitant orifice area (EROA) was calculated using the standard and modified PISA methods and was compared to a reference value obtained from an electromagnetic flowmeter. Second, in order to clinically validate the in vitro findings, 16 patients were examined with two-dimensional (2D) echocardiography. The results were analyzed by comparing the PISA method and the echocardiographic 2D quantitative volumetric method. RESULTS: Both hemicylindrical and hemiellipsoidal PISA assumptions improved the quantification of the EROA for oblong MR compared with the traditional PISA method (hemispherical PISA assumption: 11 ± 4.6 mm2, P < .01; hemicylindrical PISA assumption: 2 ± 0.8 mm2, P = .83; hemiellipsoidal PISA assumption: 6 ± 3.7 mm2, P = .05). In the case of multiple jets of different sizes, an improved EROA calculation was measured when both jets were considered (single hemispherical PISA assumption: 4.5 ± 0.7 mm2, P < .01; double hemispherical PISA assumption: 2 ± 1.1 mm2, P = .64). CONCLUSION: For a correct diagnosis of MR, the PISA geometry must be considered. A measurement of both PISA radius and PISA width is necessary for an accurate quantification of an oblong MR. In the case of a double-jet MR, a measurement of the two radii is recommended.
