Biomarkers and early detection of late onset anthracycline-induced cardiotoxicity in children.
BACKGROUND
The main strategy for minimizing anthracycline cardiotoxicity is early detection of high-risk patients.


OBJECTIVE
To investigate the role of cardiac biomarkers; cardiac troponin T (cTnT) and N-terminal probrain natriuretic peptide (NT-pro-BNP), and tissue Doppler imaging (TDI), as early predictors of chronic cardiotoxicity in survivors of acute leukemia.


METHODS
We carried a retrospective study on 50 asymptomatic survivors of acute leukemia who received anthracycline in their treatment protocols. All patients underwent blood sampling to determine the levels of NT-pro-BNP and cTnT along with conventional echocardiography and TDI.


RESULTS
None had abnormal cTnT levels. About 20% had abnormal NT-pro-BNP levels. Diastolic dysfunction of the left ventricle was the most significant in conventional echocardiography. TDI was superior as it detected myocardial affection in 10% more than echo. TDI demonstrated global myocardial damage with significant aberrations in peak myocardial velocities and ratios.


CONCLUSIONS
NT-pro-BNP can be used as a sensitive cardiac biomarker in monitoring of anthracycline-induced cardiotoxicity. Follow up is essential to validate the role of NT-pro-BNP as an early marker for late onset anthracycline-induced cardiotoxicity. Tissue Doppler is marvelous as it could detect early cardiac dysfunction even in those with normal study by conventional echocardiography.
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt.
Laila M
LM
Sherief
Ahmad G
AG
Kamal
E A
EA
Khalek
Naglaa M
NM
Kamal
Attia A A
AA
Soliman
Asmaa M
AM
Esh
D000293:Adolescent; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D054715:Cardiotoxins / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D005260:Female; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D015456:Leukemia, Biphenotypic, Acute / Q000188:drug therapy; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D012189:Retrospective Studies; D017741:Survivors; D020107:Troponin T / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis*
D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D015415:Biomarkers; D054715:Cardiotoxins; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain