Mitral regurgitation after anthracycline treatment for childhood malignancy.
OBJECTIVE
To investigate the new onset of mitral regurgitation in patients with otherwise normal echocardiograms after anthracycline treatment and to assess its relation to other selected indicators of myocardial damage.


METHODS
Prospective echocardiographic and electrocardiographic study.


METHODS
Tertiary paediatric cardiac referral centre.


METHODS
305 patients, aged 2-33 years (median 14 years), treated with cumulative anthracycline doses of between 150-450 mg/m(2) (median 180 mg/m(2)) for childhood malignancy.


METHODS
Colour flow Doppler detection of mitral regurgitation and its relation to changes in echocardiographic indices of left ventricular function (systolic and diastolic dimensions, fractional shortening) and to changes in the 12 lead ECG; and the prevalence of mitral regurgitation in the anthracycline treated patients in comparison with previously studied normal volunteers of similar age.


RESULTS
34 patients (11.6%) developed ultrasound detectable mitral regurgitation, which was not apparent clinically, during or after anthracycline treatment, compared with only 1.8% of a normal population of similar age (p < 0.0001). Nine of the 34 also developed non-specific T wave abnormalities. All 34 patients had normal systolic function at the time of initial detection of mitral regurgitation, but four later developed impaired left ventricular function (5, 11, 20, and 27 months after the first detection of mitral regurgitation).


CONCLUSIONS
Mitral regurgitation occurs much more often in patients treated with anthracyclines than in the normal population. Echocardiographic detection of new mitral regurgitation with or without ECG abnormalities may be an early predictor of anthracycline cardiomyopathy.
Department of Paediatric Cardiology, Yorkshire Heart Centre, E Floor, Jubilee Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK.
J
J
Allen
J D
JD
Thomson
I J
IJ
Lewis
J L
JL
Gibbs
D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000139:chemically induced* / Q000175:diagnosis*; D011446:Prospective Studies; D016277:Ventricular Function, Left
D000903:Antibiotics, Antineoplastic