• anthracycline;
  • cardiotoxicity;
  • children;
  • myocardial deformation;
  • strain;
  • strain rate;
  • tissue Doppler imaging



To detect subtle changes in myocardial function in pediatric cancer patients treated with high dose anthracyclines.


In all, 19 pediatric cancer patients with no cardiotoxicity findings treated with a cumulative anthracycline dose of ≥350 mg/m2 and healthy participants of the same age were included in the study. Transthoracic echocardiography measurements, pulsed-wave tissue Doppler from the basal portions of all walls and strain and strain rate imaging of all walls from basal portion were obtained.


A total of 19 patients (13 boys and six girls) and 17 participants (10 boys and seven girls) in the control group were enrolled. Three patients had subnormal ejection fraction (EF) and fractional shortening (FS) values. There was no significant difference in EF and FS between the two groups. The left ventricle isovolumic relaxation time was prolonged (P = 0.02) and the mitral color propagation velocity was decreased in patients (P = 0.001). Peak systolic strain and strain rates of the right ventricle, septal, lateral and inferior wall basal region of the left ventricle were significantly lower in patients than controls (all P < 0.05). Tissue Doppler measurements of early and late diastolic myocardial velocities of the right ventricular free wall, lateral wall of left ventricle and septum, and peak systolic myocardial velocity of the left ventricle anterior wall were significantly lower in patients (all P < 0.05).


Myocardial Doppler and deformation imaging techniques provide a thorough evaluation of cardiac functions with the advantage of detecting subtle early changes before a global cardiac functional impairment occurs.