[Evaluation of late cardiac toxicity of anthracycline in childhood].

OBJECTIVES

To examine left ventricular function in patients previously treated with anthracycline for childhood malignancies. To evaluate the importance of age at the beginning of therapy, of total cumulative dose and of length of follow-up on late cardiac effects of anthracyclines.

DESIGN

Cross sectional echocardiography study of left ventricular function.

PATIENTS

Eighteen patients surviving between 1 and 9 years (median 2 years) from end of chemotherapy. Cumulative doses were between 120 and 550 mg/mq (median 275 mg/mq). Age at the beginning of chemotherapy was between 1.8 and 12.25 years (median 5.17 years). Nineteen healthy subjects were also studied as control group.

METHODS

Assessment of transmitral diastolic pulsed wave Doppler flow patterns and of transaortic pulsed wave Doppler flow patterns. Evaluation of systolic function measured by M-mode echocardiography.

RESULTS

Patients compared to controls showed a significative reduction of Ejection Fraction, of Shortening Fraction, of peak early phase to peak atrial phase filling velocity ratio and an increase of peak atrial phase filling velocity and of time-velocity integral of peak filling atrial phase. These alterations were more evident at doses higher than 250 mg/m2, in patients whose therapy started before 5 years of age and in patients whose follow-up was longer than 5 years.

CONCLUSIONS

Significant abnormalities of systolic and diastolic function may appear some years after the end of anthracycline therapy for childhood malignancies. Therefore patient's continued follow-up is necessary in order to guide patient care and to better chemotherapeutic protocols.