Original ArticlesCardiorespiratory exercise capacity and its relation to a new doppler index in children previously treated with anthracycline*,**
Introduction
Anthracycline is one of the most important chemotherapeutic agents used in the treatment of a wide range of childhood cancers, but its total dose is limited by its critical cardiac toxicity. Manifestations of resting ventricular systolic and diastolic dysfunction have been reported during anthracycline administration as well as after short- and long-term follow-up periods.1, 2, 3, 4, 5, 6, 7 Exercise intolerance is a cardinal symptom of patients treated with anthracycline.6, 8, 9 However, the factors that limit the exercise capacity of these patients remain uncertain.
Recently, the Tei index, a new Doppler index combining systolic and diastolic time intervals of cardiac function, has been proposed. The index is defined as the sum of isovolumic contraction and relaxation times divided by ejection time; it is independent of heart rate and can be easily and reproducibly obtained.10, 11, 12 The index discriminates between healthy persons and those with various heart diseases. Furthermore, this index has been reported to be useful for early detection of subclinical cardiac global dysfunction during chemotherapy with anthracycline.13 This index potentially can allow the assessment of cardiac reserve and enable earlier and more accurate detection of myocardial dysfunction. The purpose of this study was to assess the exercise capacity of patients treated with anthracycline and to evaluate the relations between the exercise capacity and conventional left ventricular (LV) systolic and diastolic parameters and this new Doppler index.
Section snippets
Subjects
Twenty-nine patients were studied at least 6 months after anthracycline therapy. They were in complete continuous remission of cancer and had not received radiotherapy to the mediastinum. The child's agreement and parental consent were obtained.
The control group consisted of 41 subjects (range 8 to 18 years) who had been referred to our hospital because of murmurs or noncardiac chest pain. These subjects were not found to have heart disease on echocardiographic and physical examinations.
Echocardiography
Studies
Results
Complete results are summarized in Tables 1 and 2.Patient Diagnosis Age (y) Heart rate (bpm) Cumulative dose (mg/m2) Anaerobic threshold (mL/min/kg) Po2 (mL/min/kg) Follow-up (mo) 1 ALL 15 88 351 8.9 15.9 20 2 ALL 14 76 461 13.9 20.4 45 3 AML 10 103 354 12.5 19.0 36 4 ALL 18 88 520 12.9 22.0 35 5 ALL 11 100 534 12.3 21.0 43 6 ALL 15 81 780 12.0 18.0 31 7 AML 15 107 476 11.8 18.7 20 8 ALL 15 65 360 10.7 18.8 18 9 NHL 19 57 377 9.8 17.6 24 10 AML 9 78 826 10.7 20.0 25 11 ALL 16 73 500 10.0 21.6 30 12 ALL 10 101 360 15.5 30.0 6 13 ALL 10 61 873 12.2 21.0 18 14 ALL 15 75 480 11.5 24.0
Discussion
In this study, we demonstrated a reduction in the exercise capacity of children treated with anthracycline. We also found that a Doppler index, defined as the sum of isovolumic relaxation and contraction times divided by ejection time, was correlated with exercise capacity. The present data suggest that in patients treated with anthracycline, LV dysfunction detected by the Tei index may be a determinant of exercise intolerance.
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Cited by (29)
Evaluation of the myocardial performance index and tissue doppler imaging by comparison to near-simultaneous catheter measurements in pediatric cardiac transplant patients
2010, Journal of Heart and Lung TransplantationCitation Excerpt :Interestingly, this statistical difference held true only for the left ventricle. In another study involving patients exposed to anthracyclines, MPI inversely correlated with performance in cardiopulmonary testing.12 In contrast, McMahon et al found that, in children with dilated cardiomyopathy, neither RVMPI nor LVMPI predicted death, transplantation or need for hospitalization.13
Evaluation of Tei Index in Heart Failure
2008, Diastology: Clinical Approach to Diastolic Heart FailureElevated Brain Natriuretic Peptide and Reduced Exercise Capacity in Adult Patients Operated on for Tetralogy of Fallot Is Due to Biventricular Dysfunction as Determined by the Myocardial Performance Index
2006, American Journal of CardiologyCitation Excerpt :The relation between exercise capacity and LV function is underscored by the significant inverse correlation between the LV Tei index and peak oxygen uptake in the TOF group (Figure 2). This has not been shown previously for operated CHD but only in children treated with anthracycline.24 Most of our patients with TOF (78%) had right bundle branch block (Table 1).
Relation of systemic ventricular function quantified by myocardial performance index (Tei) to cardiopulmonary exercise capacity in adults after mustard procedure for transposition of the great arteries
2005, American Journal of CardiologyCitation Excerpt :The interrelation between exercise capacity and system ventricular function in our study is underscored by a significantly inverse correlation between the Tei index and VO2max in the TGA group (Figure 2). This has not been shown previously for operated congenital heart disease but in children treated with anthracycline.20 In our study cohort, the patients with TGA had significantly lower heart rates and blood pressures under exercise.
Effect of central hypothyroidism on Doppler-derived myocardial performance index
2004, Journal of the American Society of EchocardiographyMyocardial performance index in pediatric patients after cardiac transplantation
2004, Journal of the American Society of Echocardiography
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Reprint requests: Kenji Harada, MD, Department of Pediatrics, Akita University School of Medicine, Akita 010-8543, Japan.
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J Am Soc Echocardiogr 2001;14:256-63