title: Protective effect of carvedilol on adriamycin-induced left ventricular dysfunction in children with acute lymphoblastic leukemia.
abstract: BACKGROUND
  Adriamycin (ADR) is a potent chemotherapeutic agent widely used in the treatment of childhood acute lymphoblastic leukemia (ALL); its clinical use is limited owing to its marked cardiotoxicity. The present study investigated the possible protective role of carvedilol on ADR-induced left ventricular dysfunction in children with ALL.
  
  
  RESULTS
  Fifty children with newly diagnosed ALL were included in this study. They were divided into 2 equal groups: 1) ADR; and 2) ADR + carvedilol. Patients were evaluated with conventional 2-dimensional echocardiographic examination (2D), pulsed tissue Doppler (PTD), and 2-dimensional longitudinal strain echocardiography (2DS) before and after therapy. Plasma lactic dehydrogenase (LDH), creatine phosphokinase (CPK), and troponin I levels were also determined before and after therapy. ADR treatment reduced left ventricular systolic dysfunction as assessed by a significant decrease in fractional shortening (FS) (2D) and global peak-systolic strain (GPSS; 2DS). In addition, ADR treatment significantly increased plasma troponin I and LDH. Pretreatment of ADR-treated patients with carvedilol resulted in a significant increase in FS (2D) and GPSS (2DS). Furthermore, carvedilol pretreatment inhibited ADR-induced increase in plasma troponin I and LDH.
  
  
  CONCLUSIONS
  These results suggested a protective role of carvedilol against ADR-induced cardiotoxicity.
authors.affiliation: Department of Pharmacology and Toxicology, College of Pharmacy, Tanta University, Tanta, Egypt. nagla_fouad@yahoo.com
authors.forename: Nagla A
authors.initials: NA
authors.lastname: El-Shitany
authors.forename: Osama A
authors.initials: OA
authors.lastname: Tolba
authors.forename: Mohamed R
authors.initials: MR
authors.lastname: El-Shanshory
authors.forename: Eslam E
authors.initials: EE
authors.lastname: El-Hawary
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D002227:Carbazoles / Q000494:pharmacology / Q000627:therapeutic use*; D000077261:Carvedilol; D002648:Child; D002669:Child Welfare; D004317:Doxorubicin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000473:pathology*; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors; D014463:Ultrasonography; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D000903:Antibiotics, Antineoplastic; D002227:Carbazoles; D011412:Propanolamines; D014665:Vasodilator Agents; D000077261:Carvedilol; D004317:Doxorubicin