Anthracyclines are effective chemotherapeutics used in approximately 60% of pediatric cancer cases but have a well-documented risk of cardiotoxicity. Existing cardiotoxicity risk calculators do not include cardiovascular risk factors present at the time of diagnosis. The goal of this study is to leverage the advanced sensitivity of strain echocardiography to identify pre-existing risk factors for early subclinical cardiac dysfunction among anthracycline-exposed pediatric patients. We identified 115 pediatric patients with cancer who were treated with an anthracycline between 2013 and 2019. Peak longitudinal left ventricular strain was retroactively calculated on 495 surveillance echocardiograms via the TOMTEC AutoSTRAIN software. Cox proportional hazards models were employed to identify risk factors for abnormal longitudinal strain (> − 16%) following anthracycline treatment. High anthracycline dose (≥ 250 mg/m² doxorubicin equivalents) and obesity at the time of diagnosis (BMI > 95th percentile-for-age) were both significant predictors of abnormal strain with hazard ratios of 2.79, 95% CI (1.07–7.25), and 3.85, 95% CI (1.42–10.48), respectively. Among pediatric cancer survivors, patients who are obese at the time of diagnosis are at an increased risk of sub-clinical cardiac dysfunction following anthracycline exposure. Future studies should explore the incidence of symptomatic cardiomyopathy 10–15 years post-treatment among patients with early subclinical cardiac dysfunction.

蒽环类药物是有效的化疗药物，用于约 60% 的儿童癌症病例，但有充分记录的心脏毒性风险。现有的心脏毒性风险计算器不包括诊断时存在的心血管危险因素。本研究的目的是利用应变超声心动图的先进灵敏度来识别蒽环类药物暴露儿童患者中预先存在的早期亚临床心功能不全的危险因素。我们确定了 2013 年至 2019 年间接受蒽环类药物治疗的 115 名儿科癌症患者。通过 TOMTEC AutoSTRAIN 软件对 495 份监测超声心动图回顾性计算了峰值纵向左心室应变。采用 Cox 比例风险模型来识别蒽环类药物治疗后异常纵向应变 (> − 16%) 的危险因素。高蒽环类药物剂量（≥ 250 mg/m ²阿霉素当量）和诊断时肥胖（BMI > 95%年龄）都是异常应变的显着预测因子，风险比为 2.79，95% CI (1.07–7.25) ) 和 3.85, 95% CI (1.42–10.48)。在儿科癌症幸存者中，诊断时肥胖的患者在接触蒽环类药物后出现亚临床心功能障碍的风险增加。未来的研究应探讨早期亚临床心功能不全患者治疗后 10-15 年症状性心肌病的发生率。