Longitudinal Trajectory of Left Ventricular Systolic Function in Children During Anthracycline‐Based Chemotherapy Assessed by Noninvasive Myocardial Work

ABSTRACT Background Noninvasive myocardial work (MW), which incorporates myocardial deformation and blood pressure, can be used to quantitatively evaluate left ventricular (LV) systolic function in children undergoing chemotherapy. However, the trajectories of MW indices (MWIs) in children during anthracycline‐based chemotherapy remain unclear. Objective To investigate the longitudinal trajectories of MWIs during anthracycline‐based chemotherapy and compare the relative changes between MWIs and conventional echocardiographic parameters. Methods and Results We retrospectively analyzed 441 echocardiograms from 102 children (median age, 7 years; 72 boys) with cancer who received anthracycline‐based treatment. Conventional echocardiographic parameters (LV ejection fraction [LVEF] and global longitudinal strain [GLS]) and MWIs (global work index [GWI], global constructive work [GCW], global work efficiency [GWE], and global wasted work [GWW]) were obtained using GE EchoPAC software. The Mantel–Haenszel Chi‐squared test revealed that GLS, GWI, GCW, and GWE all worsened during chemotherapy (all p < 0.05 for trend), with this deterioration appearing when the cumulative dose of anthracyclines reached 30–60 mg/m 2 . However, no significant trends were observed for LVEF and GWW (both p > 0.05 for trend). The linear mixed models indicated that GLS and GWE exhibited a consistent downward trend, whereas GWI and GCW experienced a plateau phase within the cumulative anthracycline dose range of 100–250 mg/m 2 . The relative changes in GWI and GCW were greater than those of GLS and GWE throughout chemotherapy. Conclusion Echocardiographic MW could provide a more sensitive assessment of anthracycline‐induced cardiotoxicity (AIC) in children, allowing timely chemotherapy adjustment or cardioprotective measures to prevent cardiac dysfunction.