Late echocardiographic findings following childhood chemotherapy with normal serial cardiac monitoring.
OBJECTIVE
Late development of myocardial dysfunction years following successful treatment of childhood malignancy with anthracyclines is well documented. There have been few studies of late cardiac performance in children in whom serial monitoring during treatment suggested normal cardiac performance, and those studies that do exist rely on the results of extensive evaluation. It was our purpose to determine whether findings consistent with known late cardiac changes could be discovered in these patients by echocardiographic monitoring similar to that routinely performed during treatment.


METHODS
A total 28 consecutive asymptomatic patients who had completed anthracycline therapy at least 3 years previously, had been free of malignant disease since the completion of therapy, and who had had normal serial echocardiographic studies during and at completion of treatment were restudied by echocardiography. Of these 28, 12 had undergone mediastinal radiation as part of their acute treatment.


RESULTS
Four patients (14%) of the study group were found to have abnormally low values for left ventricular shortening and ejection fractions. All four had also received mediastinal radiation. The remaining 24 patients, while having values for shortening fraction within the normal range, had, as a group, experienced a significant decrease in echocardiographic left ventricular shortening since completion of treatment. In these patients, left ventricular wall thickness had not increased commensurate with growth in body size and left ventricular cavity dimension.


CONCLUSIONS
The known incidence of late asymptomatic cardiac dysfunction is confirmed despite the presence of persistently normal echocardiographic monitoring studies during and at completion of anthracycline treatment. Additionally, as a population, these patients show impaired myocardial growth over time, placing them at risk for future myocardial failure. Normal echocardiographic monitoring studies during antineoplastic treatment in children may not necessarily predict that patients will be free of the development of late cardiac dysfunction. Routine serial echocardiographic monitoring can, however, be helpful in the long-term management of these patients.
Johnson
G L
GL
Department of Pediatrics, University of Kentucky Medical Center, Lexington 40536, USA.
Moffett
C B
CB
Geil
J D
JD
Greenwood
M F
MF
Noonan
J A
JA
D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects; D006333:Heart Failure / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D006334:Heart Function Tests; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000188:drug therapy; D009369:Neoplasms / Q000188:drug therapy
D000903:Antibiotics, Antineoplastic