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Recovery of left ventricular function following discontinuation of anthracycline chemotherapy in children
Insights
Anthracycline chemotherapy can impair left ventricular (LV) function in children, causing a significant decline during treatment. However, LV function often recovers after stopping anthracyclines, highlighting echocardiography
Area of Science:
- Pediatric Cardiology
- Cardiotoxicity
- Oncology
Background:
- Anthracyclines are potent chemotherapy agents used in pediatric oncology.
- Cardiotoxicity is a known side effect of anthracycline treatment.
- Left ventricular (LV) function can be affected by chemotherapy.
Purpose of the Study:
- To evaluate left ventricular (LV) performance in children undergoing anthracycline chemotherapy.
- To assess the reversibility of chemotherapy-induced LV dysfunction.
- To determine the utility of echocardiography in monitoring LV function during and after anthracycline treatment.
Main Methods:
- Echocardiographic assessment of LV function in 41 children.
- Measurements included LV shortening fraction and velocity of circumferential fiber shortening.
- Evaluation performed before, during, and after anthracycline chemotherapy.
Main Results:
- LV function was normal before treatment.
- A significant decline in LV function was observed during anthracycline therapy (P < .01).
- LV function improved within 1-6 months after treatment cessation, with most patients returning to normal.
Conclusions:
- Anthracycline chemotherapy can cause reversible left ventricular (LV) dysfunction in children.
- Echocardiography is a valuable tool for detecting and monitoring anthracycline-induced cardiotoxicity.
- Irradiation may be a confounding factor in LV recovery.
Abstract:
Echocardiographic evaluation of left ventricular (LV) performance was performed in 41 children during and following anthracycline chemotherapy. Prior to treatment LV function was normal in all patients; LV shortening fraction was 35.2 +/- 0.7% and percent of predicted velocity of circumferential fiber shortening was 110 +/- 20%. However, the indices measured concurrent with the final anthracycline dose (mean = 308 +/- 16 mg/sq m) demonstrated a significant decline in LV function. The LV shortening fraction had decreased to 29.5 +/- 0.8% and percent of predicted velocity of circumferential fiber shortening decreased to 94 +/- 4% (P less than .01). Four of the eight patients with evidence of significant LV dysfunction had received thoracic or upper abdominal irradiation. Following cessation of anthracycline therapy, LV function improved within one to six months and had returned to normal in all but two patients, both of whom received irradiation. Echocardiography is useful for the identification of anthracycline-induced LV dysfunction. With discontinuation of further anthracycline administration the functional decline in LV performance appears to be reversible.
