Acute Ventricular Dysfunction After Doxorubicin-Based Induction Therapy for Pediatric Acute Lymphoblastic Leukemia

Background Doxorubicin is an important drug used in the treatment of children with acute leukemia, and cardiotoxicity is the most serious complication due to its use. The cardiac dysfunction due to doxorubicin can be acute, early, or late. Echocardiography is a non-invasive tool and can be employed to detect clinical and subclinical cardiac dysfunction and plan treatment strategies accordingly. Materials and methods Twenty-eight children with acute lymphoblastic leukemia were enrolled. Echocardiography was done at baseline and 72 h after induction dose of doxorubicin. Conventional and tissue Doppler imaging parameters were obtained and compared. Results After the induction dose of doxorubicin, both ventricles developed systolic and diastolic dysfunction. Tricuspid annular plane systolic excursion significantly decreased after doxorubicin (20.0±4.95 mm vs. 19.40±4.90 mm). Right ventricular myocardial performance index and isovolumetric relaxation times increased after doxorubicin (0.38±0.08 vs. 0.41±0.08 and 41.4±1.8 ms vs. 43.1±12.6 ms, p<0.05, respectively). Tricuspid E velocity decreased (62.3±8.35 cm/s vs. 60.1±7.34 cm/s, p<0.01) as well as tricuspid E/A ratio after doxorubicin (1.54±0.26 vs. 1.40±0.23, p<0.01). The left ventricular fractional shortening and ejection fraction decreased after doxorubicin (32.1±2.26% vs. 31.4±2.27% and 64.60±4.69% vs. 63.10±4.63%, respectively). Left ventricular myocardial performance index and isovolumetric relaxation times were increased after doxorubicin (0.44±0.05 vs. 0.46±0.06 and 58.6±8.75 ms vs. 60.3±10.1 ms, respectively). Mitral E velocity is reduced (85.6±11.3 cm/s vs. 83±11.9 cm/s) and tricuspid E/A ratio is also reduced after doxorubicin (1.78±0.43 vs. 1.63±0.39). Conclusion Both systolic and diastolic dysfunctions are seen after doxorubicin. Echocardiography should be employed for early diagnosis of clinical and subclinical cardiac dysfunction and timely initiation of management to prevent progression.