Serial doppler echocardiographic evaluation of anthracycline induced left ventricular dysfunction in children

Heo, Nam Geun; Hyun, Myung Chul; Lee, Sooo Kun; Lee, Sang Bum

Abstract

Anthracycline drugs are chemotherapeutic agents highly effective against a wide range of neoplasms. However, its administration may be complicated by cardiotoxic reactions. There is a continuum of increasing risk with increasing total dose of drug rather than an absolute cutoff point for total dose drug of that should not be exceeded under any circumstances. At the present time it appears that a potentially important clinical application of Doppler echocardiography would be the noninvasive evaluation of global ventricular function. To assess the value of serial Doppler echocardiography in detecting early signs of anthracycline cardiotoxicity in children, we studied 50 patients (35 male and 15 female children, age range 1.6 to 20 years) admitted to the Department of Pediatrics in the Kyungpook National University Hospital for treatment of neoplasia between July 20, 1988 and April 20, 1991 prospectively. Eight three Doppler echocardiograms were performed prior to and at intervals after receiving varying doses of anthracycline and aortic velocity, acceleration time (AT), ejection time (ET), ratio at AT to ET (AT/ET), acceleration and velocity time integral, and mitral velocity of E and A waves and velocity time integral were measured. Pretreatment parameters were not differ from those of normal age matched control children. The aortic AT/ET showed significant increase with increase in anthracycline dosage, being a mean (+/-SD) of 0.30+/-0.07 in the pretreatment group, 0.33 (+/-0.09) after 100 mg/M2 (p<0.001) but the mitral E/A peak velocity ratio showed significant decrease, being a mean (+/-SD) of 1.47 (+/-0.26) in the pretreatment group and 1.36 (+/-0.09) after 400mg/M2(p<0.05). We could not reliably ascertain the relationship between Doppler echocardiographic changes and development of anthracycline cardiomyopathy but these preliminary data show that Doppler echocardiography may detect incremental changes in left ventricular function in anthracycline cardiomyopathy. It is hoped that further study at higher dose levels in large populations for a sufficient follow up time will identify those patients with a risk of developing cardiomyopathy and then manage them appropriately.