Cor Vasa 2002, 43(11):461-465
Late cardiotoxicity following anthracycline therapy for malignancies in pediatric age
- 1 Oddělení funkčního vyšetřování, Fakultní nemocnice Brno-Bohunice
- 2 I. dětská interní klinika, Fakultní nemocnice Brno, pracoviště Fakultní dětská nemocnice J. G. Mendela, Brno, Česká republika
Late cardiotoxicity is a serious complication of anthracycline-based chemotherapy in pediatric age. It is a relatively frequent complication, often with a subclinical course and, in many cases, with a fatal outcome. Clinically, late cardiotoxicity manifests itself by the development of chronic heart failure. Its incidence, in the first decade following chemotherapy, has been reported to be 5-10%.
Based on echocardiographic findings, subclinical cardiotoxicity occurs in 20-65%, most often taking the form of increased systolic left ventricular wall stress, wall thickening and decreased wall excursions, impaired diastolic function, and an asymptomatic decrease in systolic function markers compared with the healthy population. Use of exercise testing raises the incidence of abnormalities to as much as 85%.
The most important risk factors of late clinical cardiotoxicity include the magnitude of the total cumulative dose, size of individual bolus anthracyclin doses, age at which the patient received treatment, and post-treatment follow-up time. The relationship of risk factors to subclinical cardiotoxicity is fairly loose.
Long-term follow-up of patients treated, in pediatric age, for malignancy with anthracyclines, primarily in the second and third decades following chemotherapy, will allow to determine the clinical relevance of subclinical cardiotoxicity and to define a policy on early pharmacological intervention.
Keywords: Late cardiotoxicity; Anthracyclines; Heart failure
Published: November 1, 2002 Show citation