title: Anthracycline-induced cardiotoxicity: prospective cohort study from Pakistan.
abstract: OBJECTIVE
  To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Aga Khan University, Karachi, Pakistan.
  
  
  METHODS
  110 children (aged 1 month-16 years).
  
  
  METHODS
  Anthracycline (doxorubicin and/or daunorubicin).
  
  
  METHODS
  All children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 year was carried out by repeated measures analysis of variance.
  
  
  RESULTS
  Mean age was 74±44 months and 75 (68.2%) were males. Acute lymphoblastic leukaemia was seen in 70 (64%) patients. Doxorubicin alone was used in 59 (54%) and combination therapy was used in 35 (32%). A cumulative dose of anthracycline <300 mg/m(2) was used in 95 (86%). Fifteen (14%) children developed cardiac dysfunction within a month and 28 (25%) children within a year. Of these 10/15 (66.6%) and 12/28 (43%) had isolated diastolic dysfunction, respectively, while 5/15 (33.3%) and 16/28 (57%) had combined systolic and diastolic dysfunction. Seven (6.4%) patients expired due to severe cardiac dysfunction. Eight of 59 (13.5%) children showed dose-related cardiotoxicity (p=<0.001). Cardiotoxicity was also high when the combination of doxorubicin and daunorubicin was used (p=0.004).
  
  
  CONCLUSIONS
  Incidence of anthracycline-induced cardiotoxicity is high. Long-term follow-up is essential to diagnose its late manifestations.
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Abdul Sattar
authors.initials: AS
authors.lastname: Shaikh
authors.forename: Ali Faisal
authors.initials: AF
authors.lastname: Saleem
authors.forename: Shazia Samad
authors.initials: SS
authors.lastname: Mohsin
authors.forename: Muhammad Matloob
authors.initials: MM
authors.lastname: Alam
authors.forename: Mehnaz Atiq
authors.initials: MA
authors.lastname: Ahmed
keywords: Chemotherapy; Oncology