Dobutamine stress echocardiography for early detection of anthracycline cardiotoxicity

In this study 18 patients (14 boys, 4 girls) treated with anthracycline therapy, mean age 18.4 ±3.2 (13?26;18) year old, mean height 167.1±6.4 (152?180;167) cm and mean weight 63.7 ±9.5 (48?80;60.5) kg and 18 healthy control participants mean age 19.2±4.0 (14?26;18.5) year old, mean height 168.8±7.8 (159?186;169.5) cm and mean weight 62.5±14.0 (41?87;59) kg were evaluated for standard and tissue Doppler imaging during the stress echocardiography. The cumulative dose of anthracycline were 281.1mg/m²± 125.9 (90-480; 300) mg/m².In the patient group significant hemodynamic alterations and ventricular dysfunctions were observed in 15mcg/kg/min Dobutamine infusions. Side effect depend on dobutamine infusion were observed only one participant (suddenly increasing blood pressure) during 5mcg/kg/dk dobutamine infusion. There were no observed side effect including arrhythmia or decreasing blood pressure.Although LV EF and FS, mitral and tricuspid inflow velocities were within normal limits in the patients, percent of left ventricle posterior wall thickness were decreased and LV ESS, LVDD and LVSD were increased at the end of the stress echocardiography. Measurement of AT, DT, ICT and IRT were significantly lower in control group compared with patient group.In tissue Doppler assessment IVS and LV S were lower in the patient group compared with control group during stress echocardiography. Left ventricle tissue S and E were higher than IVS tissue S and E in both group. Although IVS and RV tissue annular S and E were higher than midwall S and E in the patient group at the beginning stress echocardiopgraphy, midwall S and E were increased at the end of the stress echocardiography. No significant differences were found between LV annular and midwall S and E in patients. Tissue LV, RV and IVS annular S and E were higher than midwall S and E in the control group during the stress echocardiography.Left ventricle flow MPI (beginning:0.40, D20:0,44) and LV ( annular beginning:0.41, D20:0.52 - midwall beginning:0.41, D20:0.52), RV (annular beginning:0.44, D20:0.53 ? midwall beginning:0.44, D20:0.56) and IVS (annular beginning:0.43, D20:0.52- midwall beginning:0.42, D20:0.50) tissue MPI were lower than in patient group compared with control group (LV flow MPI: beginning:0.33, D20:0.30, LV tissue MPI beginning: 0.35- D20: 0.36, IVS MPI beginning :0.35- D20:0:34, R MPI beginning:0.34- D20: 0.35) during the stress echocardiography. Although positive correlation were found between LV flow MPI and LV tissue MPI at the beginning dobutamine infusion in patient group, LV tissue MPI were higher than LV flow MPI at the end of the stress echocardiography. In patient group positive correlation between LV tissue annular and midwall MPI were determined.We found negative correlation between percentage of left ventricle posterior wall thickness and cumulative dose of anthracycline in the D20, whereas were found positive correlation between cumulative dose of anthtracycline and RV tissue MPI in the D10 and D20.Late anthracycline cardiotoxicity should be evaluated for early detections; LV, RV and IVS tissue annuler and midwall S, E, A, E/A and MPI.