title: Ventricular systolic reserve in asymptomatic children previously treated with low doses of anthracyclines: a longitudinal, prospective exercise echocardiography study.
abstract: BACKGROUND
  The time course of mild cardiotoxicity induced by anthracycline remains unknown. The aim of this study was to evaluate the long-term evolution of decreased myocardial reserve in children previously treated with a cumulative dose of anthracycline up to 100 mg/m(2).
  
  
  METHODS
  Twenty-seven asymptomatic cancer survival patients (25 with lymphoblastic leukemia), in continuous remission and off treatment for >12 months with no alterations in conventional echocardiograms were evaluated by exercise echocardiography at 37 ± 15.4 months (T1) and 101 ± 24 months (T2) after finishing treatment (ADRIA group). This group was compared with 25 healthy individuals (control group) similar to the ADRIA group with respect to age and body surface area (BSA). All individuals underwent treadmill exercise testing according to Bruce protocol. Echocardiograms were performed before and immediately after exercise.
  
  
  RESULTS
  The groups were similar regarding cardiac structure and left ventricular (LV) systolic function at rest at T1 and T2. The growth of LV posterior wall thickness related to BSA was lower in the ADRIA group at T2. Post exercise, smaller LV ejection indexes and attenuated changes in the afterload in ADRIA group were observed at T1 and T2.
  
  
  CONCLUSIONS
  The decreased systolic reserve induced by a low dose of anthracycline in asymptomatic children and adolescents remains unaffected over a 5-year period, suggesting that positive outcomes in chronic cardiotoxicity would be expected in patients with mild impairment after anthracycline treatment.
authors.affiliation: Marilia Medical School, São Paulo, Brazil. fabio.icm@icm.com.br
authors.forename: Fabio V
authors.initials: FV
authors.lastname: Guimaraes-Filho
authors.forename: Doralice M
authors.initials: DM
authors.lastname: Tan
authors.forename: Joao C F
authors.initials: JC
authors.lastname: Braga
authors.forename: Alexandre
authors.initials: A
authors.lastname: Rodrigues
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Waib
authors.forename: Beatriz B
authors.initials: BB
authors.lastname: Matsubara
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D015444:Exercise; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011446:Prospective Studies; D012146:Rest; D013599:Systole; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic