title: Myocardial function and postmortem myocardial histology in children given anthracycline therapy for cancer.
abstract: In an autopsy series of children with cancer, histopathologic myocardial changes caused by anthracyclines (A) were evaluated. The series comprised three groups: group A, 9 patients given A whose myocardial function had been evaluated before death; group B, 10 patients given A, but no lifetime echocardiographic evaluation; group C, 8 patients treated with chemotherapy regimens not including A. Both the cumulative A dose (P < 0.01) and the age of the patient at death (P < 0.001) were correlated with the pathologic changes in the myocardium. In echocardiography of group A patients, left ventricular (LV) contractility was subnormal in 5 (56%) patients, and the afterload was elevated in 3 (33%); the morphologic changes correlated with the LV wall stress (= afterload) (P < 0.05) and with LV fractional shortening (P < 0.04). We conclude that clinical decisions about A therapy should be based on cumulative A dose and myocardial function tests. Myocardial biopsies should be restricted to selected cases.
authors.affiliation: Children's Hospital, University of Helsinki, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Pihkala
authors.forename: H
authors.initials: H
authors.lastname: Sariola
authors.forename: U M
authors.initials: UM
authors.lastname: Saarinen
mesh_terms: D000293:Adolescent; D001344:Autopsy; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003630:Daunorubicin / Q000009:adverse effects*; D004317:Doxorubicin / Q000009:adverse effects*; D004452:Echocardiography / Q000187:drug effects; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006334:Heart Function Tests; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D008297:Male; D009206:Myocardium / Q000473:pathology*; D009369:Neoplasms / Q000188:drug therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy
chemical_list: D004317:Doxorubicin; D003630:Daunorubicin