Uncovering Subclinical Cardiotoxicity Across Chemotherapy Phases in Pediatric Oncology Cardiovascular Risk Stratification and Comprehensive Monitoring of Cancer Therapy-Related Cardiac Dysfunction in Pediatric Patients

Esther Aurensanz Clemente^1,2*Patricia Garcia-Canadilla^2,3Maite Gorostegui⁴Cristina Rivera⁴María Clara Escobar-Díaz^2,5Paula Randanne⁶Andres Morales La Madrid⁴Joan Sanchez-de-Toledo^2,5,7*

• ¹Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain
• ²Cardiovascular Research Group iCare4Kids, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain
• ³Data and Digital Strategy Department, Sant Joan de Déu Hospital, Esplugues de Llobregat, Spain
• ⁴Pediatric Cancer Center Barcelona, Department of Oncology, Sant Joan de Déu Hospital, Esplugues de Llobregat, Spain
• ⁵Department of Cardiology, Sant Joan de Déu Hospital, Esplugues de Llobregat, Spain
• ⁶Sant Joan de Déu Hospital, Esplugues de Llobregat, Spain
• ⁷University of Pittsburgh, Pittsburgh, United States

ABSTRACT Background and objectives: Advances in cancer therapies have significantly improved pediatric survival rates in children. However, treatment-related toxicities although associated toxicities remain common. This study aims to evaluate e objective of this study was to analyze the incidence and characteristics of of cardiotoxicity in a pediatric cancer populationcohort. Methods: This prospective study included pediatric patients who underwent received chemotherapy between September 2020 and March 2023. Patients were categorized divided into five groups according to treatment phase: baseline, early treatment, late treatment, end-of-treatment, and relapse. Cardiovascular evaluation included anthropometric assessment, laboratory biomarkersanalytical, electrocardiogram (ECG) and functional echocardiography measurements. Patients were stratified for cardiotoxicity into cardiotoxicity groups according to pediatric and adult adult/pediatric clinical practice guidelines. Results: 265 patients were included (. The mean age was 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 the patients presented a >10% decrease in LVEF from their baseline value. 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 analytical criterialaboratory findings, patients undergoing in treatment groups had moreshowed greater cardiac involvement compared with those in other groups.to the rest of the groups. Conclusions: Although the overall The incidence of overt ventricular dysfunction in the pediatric population was low, the use of ECG and GLS enhanced the sensitivity for detecting . However, when ECG and GLS were used to evaluate cardiac status of the patients, the sensitivity for the detection of subclinical dysfunction was increased.cardiac impairment in pediatric patients receiving chemotherapy.