Fukumi Daichi, Uchikoba Yohko, Maeda Miho, Ogawa Shunichi
Department of Pediatrics, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan.
Pediatr Int. 2002 Apr;44(2):134-40. doi: 10.1046/j.1328-8067.2001.01526.x.
The aim of the present study was to investigate the detection of anthracycline cardiotoxicity by signal-averaged electrocardiography (SAE) in children with cancer.
There were 29 patients with a cumulative anthracycline (ATC) dose of 75-600 mg/m2. None of them had congestive heart failure. Patients underwent SAE just before (detection of chronic cardiotoxicity) and just after (detection of acute cardiotoxicity) ATC therapy. Echocardiography and Holter electrocardiography were performed at the same time. The rates of abnormal SAE, echocardiography, and electrocardiogram findings were calculated and compared for every 100 mg/m2 of ATC.
The SAE showed a significantly higher detection rate for acute cardiotoxicity was at a cumulative ATC dose of less than 400 mg/m2 when compared with other methods (P < 0.05). The lowest dose at which acute cardiotoxicity was detected by SAE was 117.3 mg/m2. The detection of chronic cardiotoxicity by SAE was significantly higher at a cumulative ATC dose of 100-400 mg/m2 when compared with other methods (P < 0.05), and the lowest value showing toxicity was 373.3 mg/m2. The lowest ATC dose causing chronic cardiotoxicity was significantly lower in patients less than 2-years-old (120.0 +/- 28.3 mg/m2) than in the other age groups (P < 0.05).
Acute and chronic ATC cardiotoxicity were detected by SAE at lower cumulative doses compared with other methods. The technique of SAE was a potentially useful method for detection of cardiotoxicity among those investigated and it provides useful information on subclinical cardiac dysfunction in patients receiving ATC therapy.
本研究旨在探讨通过信号平均心电图（SAE）检测癌症患儿的蒽环类药物心脏毒性。
29例患者蒽环类药物累积剂量（ATC）为75 - 600mg/m²。他们均无充血性心力衰竭。患者在ATC治疗前（检测慢性心脏毒性）和治疗后（检测急性心脏毒性）接受SAE检查。同时进行超声心动图和动态心电图检查。计算每100mg/m² ATC时SAE、超声心动图和心电图异常结果的发生率并进行比较。
与其他方法相比，SAE显示在累积ATC剂量小于400mg/m²时，急性心脏毒性的检测率显著更高（P < 0.05）。SAE检测到急性心脏毒性的最低剂量为117.3mg/m²。与其他方法相比，SAE在累积ATC剂量为100 - 400mg/m²时慢性心脏毒性的检测率显著更高（P < 0.05），显示毒性的最低值为373.3mg/m²。导致慢性心脏毒性的最低ATC剂量在2岁以下患者（120.0±28.3mg/m²）中显著低于其他年龄组（P < 0.05）。
与其他方法相比，SAE在较低累积剂量时就能检测到急性和慢性ATC心脏毒性。SAE技术是所研究的检测心脏毒性的潜在有用方法，它为接受ATC治疗的患者亚临床心脏功能障碍提供了有用信息。
