Echocardiographic assessment of anthracycline cardiotoxicity in children

Abstract

Adriamycin and daunomycin are highly effective anti-tumor agents but have been known to be cardiotoxic in dosages > 500 mglm'. Echocardiograms were performed in 54 pediatric patients with a variety of malignant diseases in an attempt to detect early evidence of anthracycline-induced cardiac toxicity. Thirty baseline studies were performed while 81 studies were done during and/or following anthracycline chemotherapy. Baseline left ventricular (LV) function was normal; shortening fraction = 34 * 1% and percent heart rate predicted velocity of fiber shortening = 109 ?; 3%. No significant reduction in LV performance occurred until cumulative doses exceeded 250 mg/m2. Between 250 mg/m2 and 450 mg/m2 mean shortening fraction = 30 f 1% (p < 0.025) and percent of predicted shortening velocity = 93 * 4% (p < 0.005). Above 450 mg/m2 a further significant decrease in LV function was noted: shortening fraction = 21 * 3% and percent of predicted shortening velocity = 63 k 10%. Two of the five patients in this group developed congestive heart failure. We currently recommend that echocardiograms be performed prior to the start of anthracycline therapy and repeated every 80 to 120 mg/m2 until a cumulative dose of 250 mg/m2 is reached. Thereafter, echocardiograms should be performed prior to each additional dose. Therapy should be discontinued when shortening fraction < 20% and percent of predicted shortening velocity < 50%. However, selected patients with satisfactory LV performance who have received dosages of 500 mg/m2 may be considered for continued chemotherapy.

Perioperative complications in patients with anthracycline chemotherapeutic agents

“…However, when we looked at the group of patients experiencing intraoperative complications, abnormal electrocardiograms or chest radiographs provided no further indication over the clinical history of congestive heart failure of a propensity to develop intraoperative and cardiovascular complications. This agrees with early work of Lewis et al 9 who determined only non-specific electrographic changes during doxorubicin therapy in asymptomatic patients. Abnormal electrocardiograms were only obtained from patients with clinically diagnosed congestive heart failure, electrocardiograms, remained normal despite shortening fractions as low as 20 per cent in asymptomatic patients.…”

An effective chemotherapeutic regimen for acute myeloid leukemia and myelodysplastic syndrome in children with Down's syndrome

“…Anthracycline therapy in childhood impairs myocardial growth in a dose-related fashion and results in clinically significant heart disease. 23,24 According to Lipshultz et al, 25 cumulative doses of more than 228 mg/m 2 of doxorubicin and an age of less than 4 years at treatment were risk factors for the subsequent development of cardiotoxicity in patients with ALL. The median cumulative dose of anthracycline in the present study was 300 mg/m 2 , and ranged from 100 to 400 mg/m 2 .…”

Evaluation of Left Ventricle Systolic and Diastolic Functions by Tissue Doppler Echocardiography in Children with Down Syndrome

“…Tissue Doppler imaging is a new type of echocardiography that has the advantage of permitting the ventricles to be studied, both in systole and diastole. Tissue Doppler imaging is not only used in evaluating ventricular systolic and diastolic functions but is also beneficial in detecting uncoordinated ventricular movements (5). It can be performed in various formats: M mode, 2D mode, and spectral pulsed wave (6).…”