***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND It has been hypothesized that the extent of acute anthracycline-induced cardiotoxicity reflects the risk for late development of heart failure . The aim of this study was to examine if short-term changes in cardiac function can be detected even after low-dose adjuvant epirubicin therapy for breast cancer when using Doppler tissue imaging of longitudinal left ventricular function . METHODS Eighty consecutive women in good cardiopulmonary health scheduled to undergo adjuvant treatment for breast cancer were included . They were examined using echocardiography and Doppler tissue imaging before and after three treatment series of epirubicin ( mean cumulative dose , 273.7 ± 46.6 mg/m(2 ) ; median time interval , 9 weeks ; range , 47 - 113 days ) . RESULTS Apart from a marginal reduction in E/A ratio , none of the conventional Doppler echocardiographic or Doppler tissue imaging indices of systolic and diastolic function were affected during epirubicin treatment . CONCLUSIONS In contrast to several previous studies using tissue Doppler and conventional echocardiography , this study did not document relevant short-term effects of low-dose epirubicin treatment on heart function Objectives To identify anthracycline-induced acute ( within 1 month ) and early-onset chronic progressive ( within 1 year ) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan . Design Prospect i ve cohort study . Setting Aga Khan University , Karachi , Pakistan . Participants 110 children ( aged 1 month–16 years ) . Intervention Anthracycline ( doxorubicin and /or daunorubicin ) . Outcome measurements All children who received anthracycline as chemotherapy and three echocardiographic evaluations ( baseline , 1 month and 1 year ) between July 2010 and June 2012 were prospect ively analysed for cardiac dysfunction . Statistical analysis including systolic and diastolic functions at baseline , 1 month and 1 year was carried out by repeated measures analysis of variance . Results Mean age was 74±44 months and 75 ( 68.2 % ) were males . Acute lymphoblastic leukaemia was seen in 70 ( 64 % ) patients .  Doxorubicin alone was used in 59 ( 54 % ) and combination therapy was used in 35 ( 32 % ) . A cumulative dose of anthracycline < 300 mg/m2 was used in 95 ( 86 % ) . Fifteen ( 14 % ) children developed cardiac dysfunction within a month and 28 ( 25 % ) children within a year . Of these 10/15 ( 66.6 % ) and 12/28 ( 43 % ) had isolated diastolic dysfunction , respectively , while 5/15 ( 33.3 % ) and 16/28 ( 57 % ) had combined systolic and diastolic dysfunction . Seven ( 6.4 % ) patients expired due to severe cardiac dysfunction . Eight of 59 ( 13.5 % ) children showed dose-related cardiotoxicity ( p=<0.001 ) . Cardiotoxicity was also high when the combination of doxorubicin and daunorubicin was used ( p=0.004 ) . Conclusions Incidence of anthracycline-induced cardiotoxicity is high . Long-term follow-up is essential to diagnose its late manifestations Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more AIMS The benefits from anthracycline chemotherapy are undermined by potentially life-threatening cardiotoxicity . Transthoracic echocardiography is the most commonly used method for monitoring cardiotoxicity , and centres on the measurement of left ventricular systolic function . The aim of this study was to utilize two-dimensional speckle tracking echocardiography ( 2DSTE ) at baseline and immediately after anthracycline chemotherapy to investigate whether patients with significant changes in systolic function after anthracycline therapy  would also develop alterations in diastolic parameters . METHODS AND RESULTS Fifty-two women with histologically confirmed breast cancer were prospect ively recruited .  Echocardiograms were performed 1 week prior to and 1 week following chemotherapy ( always before adjuvant trastuzumab or thoracic radiotherapy ) . Conventional Doppler , tissue velocity imaging ( TVI ) , and 2DSTE were used to measure diastolic function . 2DSTE measurements included longitudinal diastolic strain , early ( E-Sr ) , and late ( A-Sr ) myocardial strain rate . 2DSTE and left ventricular ejection fraction ( LVEF ) were used to measure longitudinal systolic function . Altered LV diastolic function ( including E-Sr ) was observed in the entire cohort after chemotherapy , with a differential reduction in participants with a post therapy LVEF < 55 % . Pre-chemotherapy systolic strain was found to predict reduced E-Sr post therapy ( P = 0.04 ) . Univariate predictors of E-Sr were LVEF post therapy ( P = 0.049 ) and systolic strain post-therapy ( P = 0.01 ) . In a multivariate analysis , systolic strain after chemotherapy  was the strongest independent predictor ( P = 0.001 ) . CONCLUSION Altered LV diastolic function was observed immediately after the administration of therapeutic doses of anthracycline chemotherapy . Furthermore , our analysis indicates that the changes in diastolic function are associated with reduced systolic function The aim of this study was to describe the acute effects of anthracyclines on left ventricular systolic and diastolic function using different echocardiographic modalities . Thirteen children scheduled to receive anthracyclines were prospect ively studied . They underwent complete 2-dimensional and Doppler echocardiographic evaluations , including tissue Doppler imaging , before the first dose and < 2 hours after each of the first 3 doses of anthracyclines ( dose range 30 to 75 mg/m2 ) . After the first dose , increased end-diastolic wall thickness , decreased wall thickening , and a prolonged myocardial performance index were noted . Parameters of diastolic function changed significantly , with a lower mitral E wave , a decreased E/A ratio , and prolonged isovolumic relaxation time . Also , reduced longitudinal early diastolic myocardial velocity and myocardial velocity acceleration during isovolumic contraction as well as reduced peak longitudinal and radial systolic strain rate and strain were noted . All these parameters remained significantly lower after subsequent doses . After the second dose , significant changes in the shortening fraction and the ejection fraction compared with baseline became apparent . After the third dose , further deterioration in radial peak systolic strain was seen . In conclusion , low to moderate doses of anthracyclines acutely induce cardiac diastolic and systolic dysfunction BACKGROUND To determine the normal range of left ventricular ( LV ) 2- dimensional ( 2-D ) strain and vendor-specific differences , a multicenter prospect i ve 2-D strain study endorsed by the Japanese Society of Echocardiography was conducted . METHODS AND RESULTS 2-D speckle tracking analysis was performed on 817 healthy subjects ( age range , 0 - 88 years ) ; the images included 3 LV short axis and 3 apical views using an ultrasound system from 1 of the 3 different vendors ( V(1 ) , n=333 ; V(2 ) , n=330 ; V(3 ) , n=337 ) . With the 2-D speckle tracking software from each vendor , radial , circumferential and longitudinal strain were measured using an 18-segment model . Inter-vendor variability was also assessed in a subset of subjects . The feasibility for 2-D strain measurements was different among the 3 vendors ( V(1 ) , 83 % ; V(2 ) , 70 % ; V(3 ) , 88 % , P<0.01 ) . The global radial ( V(1 ) , 54.6±12.6 % ; V(2 ) , 36.3±8.2 % ; V(3 ) , 51.4±8.0 % ) , circumferential ( V(1 ) , -22.8±2.9 % ; V(2 ) , -22.2±3.2 % ; V(3 ) , -30.5±3.8 % ) , and longitudinal ( V(1 ) , -21.3±2.1 % ; V(2 ) , -18.9±2.5 % ; V(3 ) , -19.9±2.4 % ) strain measurements were significantly different for each of the vendors . Segmental strain was also different between the 3 vendors . On inter-vendor analysis , vendor agreement ranged from mild to moderate . CONCLUSIONS Reference values are provided for normal 2-D strain for 3 different ultrasound vendors . Due to a low inter-vendor agreement , 2-D strain data are not interchangeable when conducting a longitudinal follow-up or a cross-sectional assessment of LV function The study aim ed to compare diastolic and systolic dysfunctions detected by echocardiography ( ECHO ) and multigated radionuclide angiography ( MUGA ) in patients with cancer in the first 3 months after anthracycline-comprising chemotherapy . Children with leukemia and solid tumors who had anthracycline-comprising chemotherapy were enrolled in the study . ECHO and MUGA were performed in all patients before the first chemotherapy course and in the first 3 month of completing anthracycline-comprising chemotherapy .  Cumulative anthracycline doses per body surface were calculated . Left ventricular systolic and diastolic functions were measured by both techniques . Twenty-one patients with a median age of 6.9 ± 3.6 years were enrolled in the study . Mean cumulative anthracycline doses were equivalent to 276 ± 83 mg/m2 doxorubicin . After anthracycline chemotherapy  , cardiac dysfunction was detected in 14 and 48 % of the patients by ECHO and MUGA , respectively . All dysfunctions detected by ECHO were systolic , whereas 29 % of the patients had diastolic and 38 % of the patients had systolic dysfunction in MUGA study . Although the study group is small , MUGA seems more sensitive in detecting anthracycline-induced systolic and diastolic cardiac dysfunctions compared to ECHO BACKGROUND Assessment of left ventricular systolic function is necessary during trastuzumab-based chemotherapy because of potential cardiotoxicity . Deformation indices have been proposed as an adjunct to clinical risk factors and ejection fraction ( EF ) , but the optimal parameter and optimal cutoffs are undefined . The aim of this study was to determine the best means of early detection of subsequent reduction of EF in patients with breast cancer treated with trastuzumab . METHODS Eighty-one consecutive women ( mean age , 50 ± 11 years ) receiving trastuzumab were prospect ively studied , 37 of whom received concurrent anthracyclines .  Conventional echocardiographic indices ( mitral annular systolic [ s ' ] and diastolic [ e ' ] velocities ) and myocardial deformation indices ( global longitudinal peak systolic strain [ GLS ] , global longitudinal peak systolic strain rate [ GLSR-S ] , and global longitudinal early diastolic strain rate [ GLSR-E ] ) were measured at baseline and at 6 and 12 months . Cardiotoxicity was defined as a > 10 % decline as a percentage of baseline EF in 12 months . RESULTS In the 24 patients ( 30 % ) who later developed cardiotoxicity , myocardial deformation indices decreased at 6 months ( GLS , P < .001 ; GLSR-S , P = .009 ; GLSR-E , P = .002 vs baseline ) , but e ' was unchanged . The strongest predictor of cardiotoxicity was ΔGLS ( area under the curve , 0.84 ) ; an 11 % reduction ( 95 % confidence interval , 8.3%-14.6 % ) was the optimal cutoff , with sensitivity of 65 % and specificity of 94 % . In sequential models , the clinical model ( χ(2 ) = 10.2 ) was improved by GLSR-S ( χ(2 ) = 14.7 , P = .03 ) and even more so by GLSR-E ( χ(2 ) = 18.0 , P = .005 ) or GLS ( χ(2 ) = 21.3 , P = .0008 ) . Discrimination improvement by adding GLS was confirmed by an integrated discrimination improvement of 18.6 % ( 95 % confidence interval , 8.6%-28.6 % ; P = .0003 ) . A net 29 % of the patients without events were reclassified into lower risk categories , and a net 48 % of the patients with events were reclassified into higher risk categories , result ing in a total continuous net reclassification improvement ( > 0 ) of 0.77 ( 95 % confidence interval , 0.33 - 1.22 ; P = .036 ) . CONCLUSIONS GLS is an independent early predictor of later reductions in EF , incremental to usual predictors in patients at risk for trastuzum 
    Output:
    
We found that conventional nonstrain diastolic parameters predicted doxorubicin-induced systolic dysfunction .