title: Growth-differentiation factor-15 and tissue doppler ımaging in detection of asymptomatic anthracycline cardiomyopathy in childhood cancer survivors.
abstract: OBJECTIVE
  Anthracyclines have led to an increased risk of cardiac morbidity and mortality. Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Tissue Doppler imaging (TDI) also has potential as a clinically useful technique for the assessment of myocardial function. Biochemical markers may be used to detect cardiac damage growth-differentiation factor-15 (GDF-15) and are emerging as a biomarker of cardiac dysfunction. The aim of this study is to assess the value of the plasma levels of GDF-15 and TDI in detecting late myocardial dysfunction in childhood cancer survivors (CCS) who were treated with anthracyclines.
  
  
  METHODS
  Thirty-eight CCS who had completed chemotherapy treatment with anthracyclines were included in this study. Control group consisted of 32 age- and gender-matched healthy volunteers. All children underwent a detailed echocardiography, which contained an M-mode, pulse Doppler and tissue Doppler imaging. However, GDF-15 and cardiac troponin-I (cTnI) were measured.
  
  
  RESULTS
  Although, systolic function of the left ventricular was similar in all groups, there were significant differences between parameters of diastolic function of the heart. The mitral valve E wave, E/A ratio, left ventricular E'm wave, and E'm/A'm ratio were different in the patients than in the controls (p = 0.049, p = 0.037, p < 0.0001, p = 0.001, respectively). The tricuspid valve E/A ratio, right ventricular E't wave, and E't/A't ratio in the patients were also different from those of the controls (p = 0.031, p < 0.0001, p < 0.0001, respectively). Mean plasma GDF-15 was significantly higher in patients than healthy controls (p = 0.027). There were no significant differences in cTnI between both groups.
  
  
  CONCLUSIONS
  Growth-differentiation factor-15 level may be used as a biomarker of anthracycline-induced cardiovascular disease severity in the CCS.
authors.affiliation: Selcuk University Medical Faculty, Department of Pediatric Cardiology, Konya, Turkey. aminederya@hotmail.com
authors.forename: Derya
authors.initials: D
authors.lastname: Arslan
authors.forename: Tugba
authors.initials: T
authors.lastname: Cihan
authors.forename: Dogan
authors.initials: D
authors.lastname: Kose
authors.forename: Husamettin
authors.initials: H
authors.lastname: Vatansev
authors.forename: Derya
authors.initials: D
authors.lastname: Cimen
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Koksal
authors.forename: Bulent
authors.initials: B
authors.lastname: Oran
authors.forename: Fikret
authors.initials: F
authors.lastname: Akyurek
mesh_terms: D000293:Adolescent; D018943:Anthracyclines / Q000008:administration & dosage*; D014408:Biomarkers, Tumor / Q000097:blood / Q000235:genetics; D009202:Cardiomyopathies / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000097:blood* / Q000235:genetics; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D017741:Survivors; D019210:Troponin I / Q000235:genetics
chemical_list: D018943:Anthracyclines; D014408:Biomarkers, Tumor; D055436:Growth Differentiation Factor 15; D019210:Troponin I
keywords: Anthracyclines; Cardiotoxicity; Childhood cancer survivors