[Early and late anthracycline-induced cardiotoxicity in childhood: non-invasive evaluation of contractility in 116 patients].
In order to evaluate the incidence and the characteristics of anthracycline-induced cardiotoxicity we studied 116 children treated with anthracyclines with echocardiography, by using load dependent and independent indexes of contractility (respectively: 1-shortening fraction of the left ventricle (D%), velocity of circumpherential shortening (VCF), telesystolic wall stress (Ses) and 2-the regression curves between D% and Ses VCF and Ses). Eighty-six were off therapy, and 30 were evaluated during induction and reinduction. Off therapy patients had a D% lower than that of controls (37.5 +/- 5.7 vs 41.3 +/- 5.0, p<0.001), but it was clearly depressed only in 8% of them. VCF was also lower than in controls (1.7% +/- 0.5 vs 2.0 +/- 0.6, p<0.001), but in no patient it was clearly depressed. Ses was higher than in controls (63.8 +/- 20.6 vs 44.5 +/- 10.5, p<0.001) and elevated in 47% of them; it was positively related to the dose of anthracyclines administered (r = 0.25, p<0.05). The regression curves between D% and Ses and VCF and Ses showed a depressed contractility in off therapy patients. Dilated cardiomyopathy was present only in 1 of them (1.16%) and regional hypokinesia in 3 (3.5%). Children studied during the acute phase had normal D%, VCF, Ses and regional wall motion during the all period of study. These results indicate that 1) anthracycline-induced cardiotoxicity in childhood is mostly a late event, 2) a long term follow-up of these patients is necessary, 3) the use of Ses and of load independent indexes, more than that of D% and VCF, is mandatory to detect the cardiac damage.
Agnoletti
G
G
Servizio di Policardiografia, Ospedale Umberto I, Brescia.
Bonazza
A
A
Pennacchio
M
M
Porta
F
F
Arrighini
A
A
D000293:Adolescent; D018943:Anthracyclines / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects*; D013997:Time Factors
D018943:Anthracyclines
Cardiotossicità precoce e tardiva da antracicline in età pediatrica: valutazione non invasiva dello stato contrattile in 116 pazienti.