Detection of early anthracycline-induced cardiotoxicity in childhood cancer with dobutamine stress echocardiography.
Asymptomatic long-term survivors of childhood cancer treated with anthracyclines may have latent cardiac dysfunction which is undetected by commonly used echocardiographic methods. A more sensitive echocardiographic screening test, dobutamine stress echocardiography, was performed on 22 patients (mean age 9.10 +/- 3.79 years) treated with 75 to 450 mg/m2 of anthracyclines (mean 210.45 +/- 127.34) and results were compared with 22 healthy age-matched control subjects. Echocardiographic Doppler studies were performed after each dobutamine infusion of 0.5, 2.5, 5 and 10 micrograms/kg/min. Although left ventricular mass was decreased and end-systolic walls stress increased in the patient group when compared with the control subjects (p < 0.01 and p < 0.05, respectively), no differences were found between shortening fraction and ejection force in control subjects and patients, at rest and during each dobutamine infusion. A decreased mitral E/A ratio (ratio of early-to-late peak filling velocity) was demonstrated in anthracycline-treated patients only during dobutamine infusion (p < 0.01). Our data showed left ventricular diastolic dysfunction during intropic stimulation with dobutamine, and suggest that dobutamine stress echocardiography is a useful technique for evaluating the cardiac status of anthracycline-treated patients on a long-term basis.
Department of Pediatrics, Gülhane Military Medical Academy, Ankara.
M K
MK
Lenk
C
C
Zeybek
V
V
Okutan
O
O
Ozcan
E
E
Gökçay
D000293:Adolescent; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D002316:Cardiotonic Agents; D002648:Child; D003630:Daunorubicin / Q000009:adverse effects*; D004280:Dobutamine; D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000209:etiology
D000903:Antibiotics, Antineoplastic; D002316:Cardiotonic Agents; D004280:Dobutamine; D004317:Doxorubicin; D003630:Daunorubicin