Bossi G, Lanzarini L, Laudisa M L, Klersy C, Raisaro A, Aricò M
Department of Pediatrics, IRCCS Policlinico, S. Matteo, Pavia, Italy.
Med Pediatr Oncol. 2001 Jun;36(6):593-600. doi: 10.1002/mpo.1135.
The risk of cardiomyopathy following exposure to anthracycline in asymptomatic long-term survivors of childhood cancer is still hard to predict and precisely quantify. To identify the impact of different cumulative doses, even within a non-high dose range, and the echocardiographic parameters suitable for evaluating cardiac function, we studied diastolic and systolic echocardiographic parameters in a cohort of patients followed in a single center.
A total of 117 subjects were studied at a median time of 7 years after treatment completion. A complete M-mode, two-dimensional and Doppler echocardiographic study was obtained at rest in all patients according to the standard recommendations of the American Society of Echocardiography.
Ninety-nine patients (85%) had completely normal cardiac function, while 18 had abnormal echocardiographic findings: 12 had one abnormal value, 5 had two, and 1 had three abnormal values. All the changes were in left ventricular dimensions, wall thickness or indices of systolic function; no alterations in left ventricular diastolic function parameters were found. None of the echocardiographic parameters correlated significantly with the cumulative dose of anthracyclines administered either at univariate analysis or after adjusting for sex, body surface area or considered risk factors.
Subjects exposed to a median cumulative dose of 214 mg/m(2) had no echographic abnormalities a median of 7 years later. We did not find any correlation between cumulative anthracycline dose and the echocardiographic parameters tested. We now offer echocardiographic follow-up to patients with mildly reduced fractional shortening and/or ejection fraction to rule out late onset dysfunction.
在儿童癌症无症状长期存活者中，接触蒽环类药物后发生心肌病的风险仍难以预测和精确量化。为了确定不同累积剂量（即使在非高剂量范围内）的影响以及适合评估心脏功能的超声心动图参数，我们在一个单一中心随访的一组患者中研究了舒张期和收缩期超声心动图参数。
在治疗完成后的中位时间7年时，共研究了117名受试者。根据美国超声心动图学会的标准建议，所有患者均在静息状态下进行了完整的M型、二维和多普勒超声心动图检查。
99名患者（85%）心脏功能完全正常，而18名患者有异常超声心动图表现：12名患者有一项异常值，5名患者有两项，1名患者有三项异常值。所有变化均在左心室尺寸、壁厚度或收缩功能指标方面；未发现左心室舒张功能参数有改变。在单因素分析或在调整性别、体表面积或考虑的危险因素后，没有一项超声心动图参数与蒽环类药物的累积剂量显著相关。
接触中位累积剂量214mg/m²的受试者在中位7年后没有超声异常。我们未发现蒽环类药物累积剂量与所测试的超声心动图参数之间存在任何相关性。我们现在为缩短分数和/或射血分数轻度降低的患者提供超声心动图随访，以排除迟发性功能障碍。
