title: [The role of dobutamine stress echocardiography in early diagnosis of cardiac toxicity in long-term survivors of asymptomatic children treated with anthracycline].
abstract: OBJECTIVE
  Long-term survivors of asymptomatic children treated with anthracycline may have cardiac toxicity without clinical findings. The subclinical cardiac toxicity could be evaluated by dobutamine stress echocardiography (DSE) with exploring effective and safe doses of dobutamine.
  
  
  METHODS
  Twenty asymptomatic survivors (mean age: 19.2+/-4.0 years) treated with cumulative dose of 282.1+/-125.9 mg/m2 of anthracycline were compared with 18 age-matched healthy volunteers. Total time completed this treatment was 10.2+/-2.2 years. This was a cross-sectional case-controlled study and patient and control groups were evaluated at the time of routine appointments. Echocardiographic studies were performed before and after each dobutamine infusion of 5, 10, 15, 20 microg/kg/min.
  
  
  METHODS
  Mann-Whitney U test was used to evaluate the difference between the groups. ANOVA for repeated measurements test was used to compare each measurement of control and patients groups and Bonferroni posthoc test was used for correction.
  
  
  RESULTS
  Hemodynamic changes are observed at the dobutamine doses of 15 microg/kg/min in the patient group. Before dobutamine infusion in the patient group only isovolumic relaxation and contraction times values were prolonged comparing to the control group. After the infusion of dobutamine ejection fraction, shortening fraction, left ventricular posterior wall thickening (%LVPWt), end-systolic wall stress (ESS), interventricular septum systolic thickening, left ventricular end-systolic and end-diastolic diameters, mitral acceleration (AT) and deceleration times values were deteriorated in the patient group compared to the control group (p=0.05 for all). The highest differences between the groups were observed in the %LVPWt, ESS and AT values at the end of test.
  
  
  CONCLUSIONS
  The DSE is an effective and safe method to demonstrate the late anthracycline cardiotoxicity. Echocardiographic evaluation should be made at rest and dobutamine dose of 20 microg/kg/min. In the early diagnosis of late cardiac toxicity; assessment of %LVPWt, AT and ESS values in addition to standard echocardiographic examination could be the guidance for early diagnosis of late cardiac toxicity.
authors.affiliation: Gazi Universitesi Tip Fakültesi, Cocuk Kardiyolojisi Bilim Dali, Ankara, Türkiye. ayildirimmd@yahoo.com
authors.forename: Ayşe
authors.initials: A
authors.lastname: Yildirim
authors.forename: F Sedef
authors.initials: FS
authors.lastname: Tunaoğlu
authors.forename: Faruk Güçlü
authors.initials: FG
authors.lastname: Pinarli
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ilhan
authors.forename: Aynur
authors.initials: A
authors.lastname: Oğuz
authors.forename: Ceyda
authors.initials: C
authors.lastname: Karadeniz
authors.forename: Rana
authors.initials: R
authors.lastname: Olguntürk
authors.forename: Deniz
authors.initials: D
authors.lastname: Oğuz
authors.forename: Serdar
authors.initials: S
authors.lastname: Kula
mesh_terms: D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D002316:Cardiotonic Agents; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004280:Dobutamine; D004305:Dose-Response Relationship, Drug; D042241:Early Diagnosis; D025401:Echocardiography, Stress; D005080:Exercise Test / Q000187:drug effects*; D005260:Female; D006331:Heart Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D012307:Risk Factors; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D002316:Cardiotonic Agents; D004280:Dobutamine