title: Is screening for abnormal ECG patterns justified in long-term follow-up of childhood cancer survivors treated with anthracyclines?
abstract: ECG and echocardiography are noninvasive screening tools to detect subclinical cardiotoxicity in childhood cancer survivors (CCSs). Our aims were as follows: (1) assess the prevalence of abnormal ECG patterns, (2) determine the agreement between abnormal ECG patterns and echocardiographic abnormalities; and (3) determine whether ECG screening for subclinical cardiotoxicity in CCSs is justified.
  
  
  
  We retrospectively studied ECG and echocardiography in asymptomatic CCSs more than 5 years after anthracycline treatment. Exclusion criteria were abnormal ECG and/or echocardiogram at the start of therapy, incomplete follow-up data, clinical heart failure, cardiac medication, and congenital heart disease. ECG abnormalities were classified using the Minnesota Code. Level of agreement between ECG and echocardiography was calculated with Cohen kappa.
  
  
  
  We included 340 survivors with a mean follow-up of 14.5 years (range 5-32). ECG was abnormal in 73 survivors (21.5%), with ventricular conduction disorders, sinus bradycardia, and high-amplitude R waves being most common. Prolonged QTc (>0.45 msec) was found in two survivors, both with a cumulative anthracycline dose of 300 mg/m2or higher. Echocardiography showed abnormalities in 44 survivors (12.9%), mostly mild valvular abnormalities. The level of agreement between ECG and echocardiography was low (kappa 0.09). Male survivors more often had an abnormal ECG (corrected odds ratio: 3.00, 95% confidence interval: 1.68-5.37).
  
  
  
  Abnormal ECG patterns were present in 21% of asymptomatic long-term CCSs. Lack of agreement between abnormal ECG patterns and echocardiographic abnormalities may suggest that ECG is valuable in long-term follow-up of CCSs. However, it is not clear whether these abnormal ECG patterns will be clinically relevant.
authors.affiliation: Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Milanthy S
authors.initials: MS
authors.lastname: Pourier
authors.affiliation: Princess Maxima Center of Pediatric Oncology, Utrecht, The Netherlands.
authors.forename: Annelies M C
authors.initials: AM
authors.lastname: Mavinkurve-Groothuis
authors.affiliation: Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Loonen
authors.affiliation: Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Jos P M
authors.initials: JP
authors.lastname: Bökkerink
authors.affiliation: Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.|Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Nel
authors.initials: N
authors.lastname: Roeleveld
authors.affiliation: Pediatric Cardiology Unit, Tel Aviv University, Tel-Aviv Sourasky Medical Centre, Tel Aviv, Israel.
authors.forename: Gil
authors.initials: G
authors.lastname: Beer
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Louise
authors.initials: L
authors.lastname: Bellersen
authors.affiliation: Pediatric Cardiology Unit, Tel Aviv University, Tel-Aviv Sourasky Medical Centre, Tel Aviv, Israel.|Children's Heart Centre, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors.forename: Livia
authors.initials: L
authors.lastname: Kapusta
mesh_terms: D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000175:diagnosis*; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D009369:Neoplasms / Q000188:drug therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic
keywords: QTc interval; anthracycline-induced cardiotoxicity; childhood cancer; echocardiography; electrocardiography; late-onset cardiotoxicity