Yu Hui, Qiu Yining, Yu Hui, Wang Zhujun, Xu Jiawei, Peng Yun, Wan Xia, Wu Xiaoyan, Jin Runming, Zhou Fen
Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Pharmacol. 2021 Mar 29;12:598708. doi: 10.3389/fphar.2021.598708. eCollection 2021.
Anthracycline-associated cardiotoxicity is frequently seen in cancer survivors years after treatment, but it is rare in patients on chemotherapy. This study aimed to investigate the clinical characteristics of cardiac disorders in children with acute lymphoblastic leukemia (ALL) during chemotherapy. A retrospective case study was conducted in children with ALL, for whom electrocardiogram (ECG) and echocardiography (Echo) were regularly assessed before each course of chemotherapy. The cardiac disorders were diagnosed according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Binary logistic regression analysis was used to identify risk factors associated with cardiac disorders. There were 171 children eligible for the study, and 78 patients (45.61%) were confirmed as having cardiac disorders. The incidence of cardiac disorders was dependent upon the cumulative dose of daunorubicin (DNR) ( = 0.030, OR = 1.553, 95% CI: 1.005-3.108). Four patients (2.34%) presented with palpitation, chest pain, and persistent tachycardia, and they were cured or improved after medical intervention. A total of 74 patients (43.27%) had subclinical cardiac disorders confirmed by ECG or Echo. ECG abnormalities were commonly seen in the induction and continuation treatments, including arrhythmias (26, 15.20%), ST changes (24, 14.04%) and conduction disorders (4, 2.34%). Pericardial effusion (14, 8.19%), left ventricular hypertrophy (11, 6.43%), a widened pulmonary artery (5, 2.92%) and valvular insufficiency (5, 2.92%) suggested by Echo occurred after induction chemotherapy. Therefore, cardiac disorders with clinical manifestations are rare and need early intervention. Subclinical cardiac disorders are common but very hidden in children during ALL chemotherapy. Regular ECG and Echo could help paediatricians to identify and monitor patients with asymptomatic cardiac disorders earlier.
蒽环类药物相关的心脏毒性在癌症幸存者治疗多年后很常见，但在接受化疗的患者中很少见。本研究旨在调查急性淋巴细胞白血病（ALL）患儿化疗期间心脏疾病的临床特征。对ALL患儿进行了一项回顾性病例研究，在每个化疗疗程前定期对其进行心电图（ECG）和超声心动图（Echo）评估。根据《不良事件通用术语标准》（CTCAE）第5.0版诊断心脏疾病。采用二元逻辑回归分析确定与心脏疾病相关的危险因素。有171名儿童符合研究条件，78名患者（45.61%）被确诊患有心脏疾病。心脏疾病的发生率取决于柔红霉素（DNR）的累积剂量（ = 0.030，OR = 1.553，95%CI：1.005 - 3.108）。4名患者（2.34%）出现心悸、胸痛和持续性心动过速，经医学干预后治愈或好转。共有74名患者（43.27%）经ECG或Echo确诊为亚临床心脏疾病。ECG异常在诱导和持续治疗中常见，包括心律失常（26例，15.20%）、ST段改变（24例，14.04%）和传导障碍（4例，2.34%）。诱导化疗后，Echo提示有心包积液（14例，8.19%）、左心室肥厚（11例，6.43%）、肺动脉增宽（5例，2.92%）和瓣膜关闭不全（5例，2.92%）。因此，有临床表现的心脏疾病很少见，需要早期干预。亚临床心脏疾病在ALL患儿化疗期间很常见但非常隐匿。定期进行ECG和Echo检查有助于儿科医生更早地识别和监测无症状心脏疾病患者。
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