Tissue Doppler imaging in detection of myocardial dysfunction in survivors of childhood cancer treated with anthracyclines (original) (raw)
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Myocardial Changes in Childhood Cancer Patients Treated with Anthracyclines
2017
Background: Anthracycline-induced cardiotoxicity in survivors of childhood cancer initially presenting as sub-clinical cardiac abnormalities that, if left undetected or untreated, can lead to clinical cardiac dysfunction. The present study aimed to evaluate the early myocardial changes that develop with anthracycline therapy. Material and Methods: In this prospective study the preanthracycline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were analyzed for cardiac dysfunction. The demographic information, including age, sex, type of anthracycline, and cumulative dose, were recorded, as well. Results: In this study, 115 patients with childhood cancer, including 81 males (70.4%) and 34 females (29.6%) with the mean age of 11.1±3.8 years were enrolled. Their normal baseline and 6-months postanthracycline echocardiographic and electrocardiographic parameters were compared for myocardial changes. Doxorubicin alone was used in 91 (79%) patients while daunorubicin alone in 24 (21%). Only 16 children (14%) received a high dose of anthracycline (cumulative dose > 300 mg/m 2). QTc interval significantly prolonged 6-months after chemotherapy than the baseline readings (P<0.001). There was a significant increase in the left ventricular dimensions, and all myocardial functional parameters were significantly deteriorated in children who received anthracycline (P<0.001). The incidence of cardiac dysfunction found more in female patients (20/28; 71.4%). Myocardial dysfunction was significantly higher among children who received a high cumulative dose of doxorubicin (P<0.001). Conclusion: The incidence of subclinical anthracycline-related cardiac dysfunction is high. Children treated with anthracycline require a long-term follow-up to identify and establish optimal prevention and management strategies that balance oncologic efficacy with long-term safety.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015
Cumulative anthracycline dose is one of the strongest predictors of heart failure (HF) after cancer treatment. However, the differential risk for cardiotoxicity between daunorubicin and doxorubicin has not been rigorously evaluated among survivors of childhood cancer. These risks, which are based on hematologic toxicity, are currently assumed to be approximately equivalent. Data from 15,815 survivors of childhood cancer who survived at least 5 years were used. Survivors were from the Emma Children's Hospital/Academic Medical Center (n = 1,349), the National Wilms Tumor Study (n = 364), the St Jude Lifetime Cohort Study (n = 1,695), and the Childhood Cancer Survivor Study (n = 12,407). The hazard ratio (HR) for clinical HF through age 40 years for doses of daunorubicin and doxorubicin (per 100-mg/m(2) increments) was estimated by using Cox regression adjusted for sex, age at diagnosis, treatment with other anthracycline agents and chest radiation, and cohort membership. In total,...
Pediatric Cardiology, 2015
Improvement in long-term survival in patients with acute childhood leukemia has led to the need for monitorization of chemotherapy-related morbidity and mortality. This study included 60 patients with acute lymphoblastic leukemia that were in remission for at least 2 years and 30 healthy controls. Systolic and diastolic function of myocardium was evaluated using conventional echocardiography and tissue Doppler imaging of the left ventricle, interventricular septum and right ventricle. Median age of patients was 11.7 years (range 10-14.9 years), and the median duration of remission was 4 years (range 2.5-5 years). All patients were treated with a low cumulative dose of adriamycin (100 mg/m 2) according to the St. Jude Total-XIIIA protocol. The ejection fraction (EF) and fractional shortening were normal in the patient and control groups, even though EF values were significantly lower in the patients (69.5 ± 2.3 vs. 72.7 ± 3 %, P \ 0.01). Myocardial systole (S m), early diastole (E m) and late diastole (A m) velocities in all segments of the myocardium were significantly lower in the patient group (P \ 0.01 for all segments). Cardiotoxicity was noted in all segments of the myocardium in the patient group, despite the fact that they were all treated with a low cumulative dose of adriamycin. Based on these findings, we think that there is no safe dose for anthracyclines and periodic echocardiographic evaluation of both the left and right ventricles must be performed in all patients treated with anthracyclines, even at low doses. Keywords Acute leukemia Á Anthracycline Á Late effects Á Children Á Tissue Doppler imaging Cengiz Bayram and İlker Ç etin have contributed equally to this study.
Background: Anthracycline induced cardiac complications are one of the most common causes of morbidity and mortality in childhood hemato-oncological malignancies despite recent advances in the diagnosis and treatment. Anthracycline causes cardio toxic effects during treatment when its level exceeds the cumulative dose. Aims and Objectives: This was aimed to evaluate cardiac complications with anthracycline and to determine associated electrocardiogram (ECG) and echocardiogram (ECHO) change with anthracycline in the hemato-oncological malignancies. Materials and Methods: The present study was conducted from January 2018 to December 2018 on sixty-nine diagnosed hemato-oncological malignancies between five to fifteen years irrespective of sex. A detailed history along with a complete blood count, biochemical investigations, chest x-ray, bone marrow aspiration, immunophenotype and other relevant investigations were performed. ECG, ECHO was done in all patients at initial presentation and during reassessment. The children were treated with the protocol UKALL-XII, Hyper-CVAD, R-CHOP, ATRA+doxorubicin, Doxorubicin+Cytarabine, ABVD. Blood level of anthracycline was done during reassessment. Results: Among the hematological malignancies, boys were 46 and girl 23. Acute lymphoblastic leukemia (ALL) was the most common 39.1% followed by acute myeloid leukemia (AML) 18.8% and Hodgkin's disease (HD) 17.3%. The mean cumulative dose of doxorubicin was 265.2±89.3 mg/m 2 and daunorubicin 270.6±59.6mg/m 2 among all malignancies. None of the patient found QRS duration more than 120 seconds. One child had QT interval more than 450 ms (p=0.001). The ECHO showed significant difference in ejection fraction (EF) during reassessment. Left ventricular dysfunction (less<50%) found in 17% children and significant reduction in EF (p=0.001) along with significant reduction in diastolic dysfunction (p=0.001).Ten (14%) children treated with R-CHOP, two (2.8%) Hyper-CVAD, twenty-five (36.2%) UKALL-XII, twelve (17.39%) ABVD, thirteen (18.8%) Doxorubicin+Cytarabine 3+7, and seven (10%) ATRA+ADM protocol. Most of the hematological malignancies treated with R-CHOP found left ventricular dysfunction. The left ventricular dysfunction in Hodgkin's disease was statistically significant (p=0.003).Four (66%) children had developed left ventricular dysfunction. Eight patients treated with doxorubicin developed left ventricular systolic dysfunction and only one with daunorubicin. Conclusions: The ECG, QRS voltage change, prolong QTc interval, and left ventricular systolic dysfunction are common in anthracycline treated hemato-oncological malignancies with cumulative dose ˃250 mg/m 2. Decrease QRS voltage more than 35% from base line was associated with left ventricular dysfunction in Hodgkin's disease.
Anthracycline-related cardiotoxicity: risk factors and therapeutic options in childhood cancers
Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 2008
Anthracyclines play an important role in chemotherapeutic regimens for a wide spectrum of childhood tumors, but they can cause cytotoxic damage to cardiac cells, especially in combination with radiotherapy. Furthermore, cardiotoxicity increases with the cumulative dose and may lead to congestive heart failure and cardiomyopathy. Other factors, including age, pre-existing cardiac disease, length of follow-up, gender, route of administration, concomitant exposure to some chemotherapeutic drugs, trisomy 21 and black race, play a role in increasing the risk of cardiac dysfunction. The prevention of anthracycline-induced cardiotoxicity is mandatory as children are expected to survive for decades after being cured of their cancer. The purpose of this work is to point out the major risk factors of cardiotoxicity in children and to summarize some strategies to limit or prevent this complication and to treat the development of acute heart failure.
Childhood Malignancy and Cardiotoxicity of Anthracyclines
Advances in Environmental Biology, 2012
Background: Anthracyclines are antitumor agents with broad spectrum activity against many childhood malignancies. An important side effect of these drugs is cardiotoxicity which may happen even years after discontinuation. Our objective was tried to determine the incidence of Anthracycline induced chronic cardiotoxicity and its risk factors in an Iranian cohort. Methods: we carried out a prospective analytic descriptive study at Children's Medical hospital, Tabriz, Iran, from 2009 to 2010. To evaluate cardiotoxicity (early or late onset), echocardiographic investigation was carried out on 80 persons who had received anthracyclines to treat lymphohematopoietic (Acute lymphoblastic Leukemia [ALL] and Lymphoma) malignancy before the echocardiographic examination. All patients were off treatment. Results: Mean age ± SD was 9.74±3.79 years old .66.25 % (53) was male and 33.75% (27) was female. M/F ratio was 1.96. 60(75%) had ALL and 20 (25%) had lymphoma. 12.50% (10 cases) had left ventricular systolic dysfunction, 25% (20 cases) had left ventricular diastolic dysfunction, and 27.5 % (22 cases) had arrhythmias. Conclusion: In the current study among survivors of childhood cancer, finding show that, incidence of arrhythmias due to Anthracyclines cardiotoxicity was greater than other side effects.
Echocardiography, 2008
Although the anthracyclines have gained widespread use in the treatment of childhood hematological malignancies and solid tumors, cardiotoxicity is the major limiting factor in the use of anthracyclines. The aim of this study was to assess the mitral annular displacement by tissue tracking in pediatric malignancy survivors who had been treated with anthracycline groups chemotheraphy and compare with the tissue Doppler and conventional two dimensional measurements and Doppler indices. In this study, 32 pediatric malignancy survivors and 22 healthy children were assessed with 2D, colour-coded echocardiography. Left ventricular ejection fraction, fractional shortening, stroke volume, cardiac output, cardiac index and diastolic functions were measured. All subjects were assessed with tissue Doppler echocardiography, mitral annular displacements, and also with tissue tracking method. We detected that peak velocity of the early rapid filling on tissue Doppler (E) was lower (p < 0.05) and the ratio of early peak velocity of rapid filling on pulse Doppler to tissue Doppler (E/E) values were statistically higher in patient group than control group (p < 0.05). Myocardial performance index values were also higher in patient group than the control group (p < 0.01). It appears that MPI is a useful echocardiograghic method than tissue tracking of mitral annular displacement in patients with pediatric cancer survivors who had subclinical diastolic dysfunction. (ECHOCARDIOGRAPHY, Volume 25, September 2008) anthracycline cardiotoxicity, tissue Doppler, tissue tracking, myocardial performance index Although anthracyclines have gained widespread use in the treatment of childhood hematological malignancies and solid tumors, cardiotoxicity is a limiting factor in the use of anthracyclines. 1 Studies of longterm pediatric survivors have shown that the incidence of cardiotoxicity increases with time. 2 The assessment of the diastolic function by Doppler echocardiography or radionuclide angiocardiography may help to detect early myocardial damage, but these functional approaches have inherent limitations in sensitivity.