Uncovering subclinical cardiotoxicity across chemotherapy phases in pediatric oncology.

Background and objectives: Advances in cancer therapies have significantly improved survival rates in children. However, treatment-related toxicities remain common. This study aims to evaluate the incidence and characteristics of cardiotoxicity in a pediatric cancer cohort. Methods: This prospective study included pediatric patients who received chemotherapy between September 2020 and March 2023. Patients were categorized into five groups according to treatment phase: baseline, early treatment, late treatment, end-of-treatment, and relapse. Cardiovascular evaluation included anthropometric assessment, laboratory biomarkers, electrocardiogram (ECG) and functional echocardiography. Patients were stratified for cardiotoxicity according to pediatric and adult clinical practice guidelines. Results: 265 patients were included (mean age 9.95 ± 5.26 years). The incidence of ventricular dysfunction was 2.3%. A decline in LVEF > 10% from baseline was observed in 16.5% of patients. Abnormal global longitudinal strain (GLS) values were found in 34.7%; significant ECG changes in 16.2%, and elevated Troponin I levels in 7.1%. Based on echocardiographic and laboratory findings, patients undergoing treatment showed greater cardiac involvement compared with those in other groups. Conclusions: Although the overall incidence of overt ventricular dysfunction was low, the use of ECG and GLS enhanced the sensitivity for detecting of subclinical cardiac impairment in pediatric patients receiving chemotherapy.