Cardiomyopathy
Acute Cardiac Functional and Morphological Changes After Anthracycline Infusions in Children

https://doi.org/10.1016/j.amjcard.2006.10.063Get rights and content

The aim of this study was to describe the acute effects of anthracyclines on left ventricular systolic and diastolic function using different echocardiographic modalities. Thirteen children scheduled to receive anthracyclines were prospectively studied. They underwent complete 2-dimensional and Doppler echocardiographic evaluations, including tissue Doppler imaging, before the first dose and <2 hours after each of the first 3 doses of anthracyclines (dose range 30 to 75 mg/m2). After the first dose, increased end-diastolic wall thickness, decreased wall thickening, and a prolonged myocardial performance index were noted. Parameters of diastolic function changed significantly, with a lower mitral E wave, a decreased E/A ratio, and prolonged isovolumic relaxation time. Also, reduced longitudinal early diastolic myocardial velocity and myocardial velocity acceleration during isovolumic contraction as well as reduced peak longitudinal and radial systolic strain rate and strain were noted. All these parameters remained significantly lower after subsequent doses. After the second dose, significant changes in the shortening fraction and the ejection fraction compared with baseline became apparent. After the third dose, further deterioration in radial peak systolic strain was seen. In conclusion, low to moderate doses of anthracyclines acutely induce cardiac diastolic and systolic dysfunction.

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Methods

We prospectively enrolled children scheduled to receive treatment with anthracyclines (doxorubicin, daunorubicin, or idarubicin) for different malignancies. Echocardiographic studies were performed before the first dose and <2 hours after each of the first 3 doses of anthracyclines. Informed consent was obtained from parents and/or patients. The study was approved by the Medical Ethical Committee of University Hospitals Leuven.

A total of 13 patients (10 male) were enrolled. The mean age at

Results

Table 2 lists the standard echocardiographic measurements of systolic and diastolic function before and after anthracycline therapy. Heart rate, systolic and diastolic blood pressure, LV mass index, and LV end-systolic and end-diastolic dimensions did not significantly change immediately after each dose compared with baseline values. There was a significant increase in end-diastolic wall thickness after the first dose that persisted after subsequent doses. Compared with baseline, a significant

Discussion

Our study shows that subsequent low to moderate doses of anthracyclines induce acute deterioration in different parameters of systolic and diastolic cardiac function. Looking at geometric parameters, increased LV myocardial wall thickness with decreased wall thickening was noted after the first dose of anthracyclines. After subsequent doses, significant decreases in fractional shortening and the ejection fraction were also seen. LV diastolic function was affected after the first dose of

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This research was partly funded by the Fund for Scientific Research Flanders (FWO Vlaanderen), Flanders, Belgium.

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