The value of ultrasonography in evaluating right ventricular function in children after antharcycline therapy

Abstract

Objective To explore the value of Tei index in evaluating right ventricular function in children with malignant disease after antharcycline therapy. Methods Thirty-four children in the malignant tumor group who were suffering from malignant tumor and hospitalized in the Fourth Affiliated Hospital of Hebei Medical University between June 2015 to December 2016 were evaluated for clinical cardiotoxicity. At the same time, 17 healthy non-tumor children taking examination during the same period in the same hospital without the congenital heart diseases, metabolic diseases, and cardiovascular injuries were selected as the healthy control group. We assessed right cardiac injury with echocardiography in the two group before the first cure, at cumulative doses of anthracycline 100, 200 and 250 mg/m2, respectively. The parameters included tricuspid E velocity and tricuspid A velocity; tricuspid annulus peak systolic velocity (s′), tricuspid annulus early peak diastolic velocity (e′) and tricuspid annulus atrial contraction (a′); isovolumic contraction time of right ventricular lateral wall basal segment (ICTR), isovolumic relaxation time of right ventricular lateral wall basal segment (IRTR) and ejection time of right ventricular lateral wall basal segment (ETR); isovolumic contraction time of interventricular septum basal segment (ICTS), isovolumic relaxation time of interventricular septum basal segment (IRTS) and ejection time of interventricular septum basal segment (ETS), then calculated Tei index and other relevant parameters by formula TeiR=(ICTR+ IRTR)/ETR, TeiS=(ICTS+ IRTS)/ETS, Tei=(TeiR+ TeiS)/2. In the case group before anthracycline chemotherapy and the control group, the t-test was used to compare the general clinical data, conventional echocardiography, tissue doppler and Tei index related parameters of children, and the sex ratios were compared with the chi-test. Variance analysis was used to compare conventional echocardiography, tissue Doppler and Tei index related parameters before the first cure, at cumulative doses of anthracycline 100, 200 and 250 mg/m2 in the malignant tumor group, and LSD-t test was used for further comparisons between groups. The bivariate Pearson correlation analysis was used to analyze the correlation between the cumulative dose of anthracycline and ICTR, TeiR, TeiS and Tei index. The linear regression analysis was used to analyze the relationship between cumulative dose of anthracycline and Tei index. Results Compared to control group, there were no significant differences in the basic clinical data and ultrasonic parameters in the case group. There were no significant differences in conventional ultrasonic and tissue Doppler indicators, ICTS, IRTS, ETS, IRTR and ETR before the first cure, at cumulative doses of anthracycline 100, 200 and 250 mg/m2. ICTR, TeiR and Tei increased at cumulative doses of anthracycline 200 and 250 mg/m2 compared with before antharcycline therapy, and the differences were statistically significant [(54±5) ms, (57±5) ms vs (50±5) ms; (0.40±0.03), (0.41±0.03) vs (0.38±0.03); (0.39±0.03), (0.41±0.03) vs (0.37±0.03); t=3.406, P=0.001; t=6.256, P<0.001; t=2.875, P=0.003; t=4.625, P<0.001; t=2.857, P=0.004; t=5.000, P<0.001]. There were no significant differences at the other two timepoints. TeiS increased at cumulative doses of anthracycline 250 mg/m2 compared with before antharcycline therapy, and the difference was statistically sifnificant [(0.40±0.04) vs (0.37±0.04), t=3.300, P=0.001]. There were no significant differences at the other two timepoints. Drug cumulative doses were positively correlated with ICTR, TeiR and Tei (r=0.482, 0.397, 0.417, all P<0.001), and had poor correlation with TeiS (r=0.279, P=0.001). Tei increased with the drug cumulative doses, and the linear regression equation could be demonstrated as Y=0.000 13X+ 0.368. Conclusion Tissue Doppler parameters, such as TeiS, ICTR, TeiR, Tei, were more sensitive in detecting abnormalities of right cardiac function, particularly for Tei index, which increased with the accumulated dose. Key words: Echocardiography; Drug therapy; Carcinoma; Tei index; Ventricular function, right; Atrial function, right; Child