Correlation of Equilibrium Radionuclide Ventriculography Scan with Two-Dimensional Transthoracic Echocardiography for Early Evaluation of the Left Ventricular Ejection Fraction after Anthracycline Treatment in Patients with Acute Lymphoid Leukemia

Introduction: Early diagnosis of cardiac toxicity caused by chemotherapy drugs in acute lymphoid leukemia (ALL) patients can prevent the occurrence of heart failure. Equilibrium radionuclide ventriculography (ERNV) has the advantage of a precise evaluation, while two-dimensional transthoracic echocardiography (2D-TTE) is more widely available. This study aimed to evaluate the correlation of the relevant cardiac toxicity parameters for patients diagnosed with ALL using both of these techniques. Material and methods: Between January 2022 and May 2024, patients with ALL were prospectively evaluated in the hematology department of Imam Khomeini Hospital in Tehran. 2D-TTE and ERNV were performed before and after two cycles of HYPER-CVAD chemotherapy. Patients with cardiac disease, cardiovascular risk or previous anticancer treatment were excluded. Results: Forty-four patients with ALL were included: 24 (54.5%) males and 20 (45.5%) females. The majority of patients (56.8%) were between 20 and 40 years old and had no history of cardiac disease or malignancies. Baseline left ventricular ejection fraction (LVEF) volumes were correlated on 2D-TTE and ERNV (r=0.5; P=0.001). Eleven patients were evaluated after therapy. LVEF values were similar (54.9±8.1 vs. 54.3±4.6; P=0.552) but without a linear correlation (r= 0.3; p=0.409). Only two cardiac parameters were significantly changed after chemotherapy: the pulmonary artery pressure (PAP) on 2D-TTE (24.3±5.5 vs 22.2±5.2; p=0.02) and the time peak filling rate (TTPFR) on ERNV (138.3±39.8 vs 170±52.9 milliseconds; p=0.004). Conclusion: Cardiac function impairment parameters on ERNV and 2D-TTE were similar before and after a cumulative dose of daunorubicin of 100 mg/m2. Before therapy, there was also a linear correlation between values. PAP decreased and TTPFR increased after chemotherapy. Keywords