Evaluation of cardiac reserved function by high-dose dobutamine-stress echocardiography in asymptomatic anthracycline-treated survivors of childhood cancer.

BACKGROUND

The aim of this study was to evaluate cardiac function and cardiac reserved function in asymptomatic anthracycline-treated long-time survivors of childhood cancer using dobutamine (DOB) stress echocardiography.

METHODS

A total of 26 patients (19 males and 7 females) were divided into four groups according to cumulative dose of anthracycline (ATC): non-anthracycline group (N group), seven cases; low anthracycline cumulative dose group (L group), five cases (<or=200 mg/m(2)); medium anthracycline cumulative dose group (M group), seven cases (200-<400 mg/m(2)); high anthracycline group (H group), seven cases (>or=400 mg/m(2)). DOB infusion was begun at 5 microg/kg per min (gamma) and increased up to 30 gamma. Cardiac function and cardiac reserved function at rest, after low-dose and high-dose DOB stress, were estimated.

RESULTS

In the H group, % left ventricular posterior wall thickening (%PWT) at rest and ratio of maximum early filling peak velocity (E) and atrial contraction peak velocity (A) from the left ventricular transmitral flow wave (E/A) and %PWT at DOB 5 gamma stress were significantly lower than in other groups (P<0.05). After DOB 30 gamma stress in groups given>00 mg/m(2) end-systolic wall stress was significantly higher and E/A and %PWT were significantly lower than those of other groups (P<0.05). ATC cumulative dose strongly correlated with %PWT after DOB 30 gamma stress (P<0.001).

CONCLUSIONS

Subclinical ATC cardiotoxicity was detected by high-dose DOB stress echocardiography at lower cumulative doses than with other methods. %PWT appears to be a useful index for detection of ATC cardiotoxicity.