A novel assessment of anthracycline-induced cardiotoxicity: topological flow data analysis in childhood cancer survivors

Anthracycline chemotherapy improves survival rates in childhood cancer patients but poses a significant risk of late-onset cardiotoxicity, potentially leading to cardiac dysfunction and heart failure. Recently, flow dynamics parameters derived from two-dimensional fluid dynamics may be sensitive indicators of cardiac dysfunction. Topological flow data analysis (TFDA) mathematically defines vortical flow structures and offers a novel approach to cardiac function assessment. This study aimed to use TFDA to analyze the left ventricular flow patterns in 90 childhood cancer survivors (CCSs) treated with anthracyclines (median age 15.1 yr) and 90 age-matched control subjects. The TFDA parameters, including vortex number, size, circulation, width of mitral inflow, and saddle points, were calculated and compared across the three age subgroups: <i>C1</i> (4-12 yr), <i>C2</i> (13-19 yr), and <i>C3</i> (20-36 yr). The CCSs in <i>group C3</i> exhibited a reduced left ventricular ejection fraction within the normal range, and the longitudinal strain decreased in <i>groups C2</i> and <i>C3</i>. Regarding TFDA parameters, the number of abnormal vortices in the early diastolic frames increased across all CCSs, with significant reductions in the width of the effective mitral inflow in <i>groups C2</i> and <i>C3</i>. Systolic circulation was reduced across all CCSs, and diastolic circulation was decreased in <i>groups C2</i> and <i>C3</i>, which correlated with age, time since chemotherapy, and cumulative anthracycline dose. TFDA parameters identified cardiac dysfunction before conventional echocardiographic markers, highlighting its potential as a novel and sensitive tool for the early detection and long-term monitoring of cardiotoxicity in CCSs and supporting its integration into clinical practice.<b>NEW & NOTEWORTHY</b> This study suggests that topological flow data analysis (TFDA) is a novel and sensitive method for assessing cardiotoxicity in childhood cancer survivors. By analyzing vortical flow parameters, including circulation and abnormal vortices, TFDA detected anthracycline-induced cardiotoxicity earlier than conventional echocardiographic indicators. The findings reveal age- and dose-dependent cardiac dysfunction, emphasizing TFDA's potential as a highly sensitive tool for long-term cardiovascular monitoring and early intervention in high-risk populations.