Late anthracycline cardiotoxicity in pediatric age

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 chemiotherapy. Cumulative doses were between 120 and 550 mg/mq (median 275 mg/mq). Age at the beginning of chemiotherapy 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 anthacycline therapy for childhood malignancies. Therefore patients' continued follow-up is necessary in order to guide patient care and to better chemiotherapeutic protocols.