Effect of Anthracycline Treatment on the Function of the Left Ventricular Heart Muscle in 155Patients Treated during Childhood on Account of Malignant Disease: Echocardiographic Study

Overview

Introduction:
The objective of the submitted work is to assess by means of echocardiographic examination inpatients in long-term remission after treatment of a malignity during childhood the incidence of altered leftventricular function and express an opinion on the presence of „late cardiotoxicity“.Patients and methods: The authors examined 155 patients who suffered during childhood or adolescence froma malignant disease and were treated by chemotherapy containing anthracyclines. The group comprised 90 boysand 65 girls aged 15 ± 4.9 years (5 - 29, median 15 years). The age at the time of establishment of the diagnosis andbeginning of treatment was 8.6 ± 4.9 years (1 - 18, median 8 years). The mean follow up period of the patients was7.3 ± 4 years (1 - 21, median 6.3 years). All patients achieved remission of the disease. The patients were givena cumulative dose of doxorubicin and possibly also daunorubicin (KD) 250 ± 131 mg/m2 (50 - 1200, median240 mg/m2). The patients were examined by echocardiography at rest. The values of the ejection fraction (EF)< 55% and fractional shortening (FS) < 30% were considered pathological. The control group was formed by40 healthy controls.Results: In 12 patients (8%) pathological FS values were recorded. Only in one patient (0.64%) cardiac failuredeveloped based on cardiomyopathy. In all patients after chemotherapy, regardless of the FS and EF values,significantly worse values of the endsystolic wall stress, mVcfc, Tei’s index and isovolumic relaxation period wererecorded as compared with the control group. A correlation was found between the administered cumulative dose of anthracycline and indicators of LV systolic function. No relationship was found with time indicators (age at timeof diagnosis, follow up period).Conclusion: The authors diagnosed during a 6-year period after terminated oncological treatment in childhoodin 11 patients subclinical cardiotoxicity (7%), in one patient cardiomyopathy withmanifestations of cardiac failure.Other indicators of subclinical damage, regardless of EF and FS values, include elevation of the afterload(endsystolic stress), impaired relaxation and elevated values of Tei’s index. The submitted findings justify thefurther follow up of patients and evaluation of the pertinent subclinical abnormalities after a longer time interval.

Key words:
late cardiotoxicity, anthracycline, echocardiography, child tumours