Late echocardiography assessment of systolic and diastolic function of the left ventricle in pediatric cancer survivors after anthracycline therapy.
BACKGROUND
The usefulness of daunorubicin (DAUNO) and doxorubicin, members of the anthracycline class of anticancer drugs, is limited by their cardiotoxicity. The purpose of our echocardiographic study was to assess the left ventricular (LV) function in long-term pediatric cancer survivors who had received DAUNO and dox as part of their therapy.


METHODS
Seventy patients and 70 age, sex, and body surface area matched healthy controls were evaluated. Among the patients, the mean cumulative anthracycline dose was 321.6 (range, 150 to 868 mg/m); the mean interval from cancer diagnosis to evaluation was 13.9 years (range, 7 to 30 y).


RESULTS
Fifteen of the 70 (21.4%) patients had a reduced ejection fraction (EF). Compared with the healthy controls, the mean EF and E/A were decreased to low normal levels in the patients, whereas deceleration time and isovolumetric relaxation time were prolonged. The E/A and deceleration time were significantly different for the females but not the males. The Tissue Doppler Index was normal but the Myocardial Performance Index was prolonged and correlated with EF (r=-0.499, P<0.001). There was a correlation between EF with cumulative anthracycline dose (r=-0.306; P=0.010) and time off therapy (r=-0.281; P=0.019). Diastolic indices suggested a tendency toward abnormal LV relaxation. Myocardial Performance Index seems to be a good index for monitoring LV status, because it was prolonged as EF decreased.


CONCLUSIONS
This study suggests that long-term survivors who received doxorubicin and DAUNO may be found to have subclinical features of myocardial dysfunction when evaluated years after the completion of therapy.
Santin
Júlio Cesar
JC
Departamento de Imagem, Setor de Ecocardiografia, Hospital do Câncer, São Paulo, Brazil. juliocsantin@uol.com.br
Deheinzelin
Daniel
D
Junior
Sérgio P C
SP
Lopes
Luis Fernando
LF
de Camargo
Beatriz
B
D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003630:Daunorubicin / Q000009:adverse effects* / Q000627:therapeutic use; D003971:Diastole; D004317:Doxorubicin / Q000009:adverse effects* / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000000981:diagnostic imaging* / Q000503:physiopathology
D018943:Anthracyclines; D000970:Antineoplastic Agents; D004317:Doxorubicin; D003630:Daunorubicin