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(Circulation. 1999;99:2367-2370.)
© 1999 American Heart Association, Inc.

Brief Rapid Communications

Automatic Border Detection Identifies Subclinical Anthracycline Cardiotoxicity in Children With Malignancy

Ikuo Hashimoto, MD; Fukiko Ichida, MD; Masayoshi Miura, MD; Takashi Okabe, MD; Hirokazu Kanegane, MD; Kei-ichiro Uese, MD; Yuji Hamamichi, MD; Takuro Misaki, MD; Shoichi Koizumi, MD; Toshio Miyawaki, MD

From the Department of Pediatrics (I.H., F.I., H.K., K.U., Y.H., T. Miyawaki) and First Division of Surgery (T. Misaki), Faculty of Medicine, Toyama Medical and Pharmaceutical University, Toyama; the Department of Pediatrics (M.M., T.O.), Toyama City Hospital; and the Department of Pediatrics (S.K.), School of Medicine, Kanazawa University, Kanazawa, Japan.

Correspondence to Fukiko Ichida, MD, Department of Pediatrics, Faculty of Medicine, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan. E-mail fukiko{at}ms.toyama-mpu.ac.jp

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/m²) 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.

Key Words: heart failure • diagnosis • echocardiography

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