Doxorubicin cardiotoxicity in children

Area of Science:

• Cardiology
• Pediatric Oncology
• Pharmacology

Background:

• Doxorubicin hydrochloride (Adriamycin) is a widely used chemotherapy agent.
• Cardiotoxicity is a significant concern with doxorubicin treatment, particularly in pediatric patients.
• Long-term effects on left ventricular function require thorough characterization.

Purpose of the Study:

• To assess the long-term impact of doxorubicin on left ventricular function in pediatric cancer patients.
• To identify reliable echocardiographic parameters for detecting doxorubicin-induced cardiotoxicity.
• To understand the temporal relationship between doxorubicin cessation and cardiac dysfunction.

Main Methods:

• Prospective collection of 588 echocardiograms from 46 pediatric patients treated with doxorubicin.
• Utilized shortening fraction (SF) and systolic time intervals for cardiac function assessment.
• Monitored patients during and after doxorubicin therapy.

Main Results:

• Shortening fraction (SF) proved more sensitive than systolic time intervals for detecting cardiotoxicity.
• Abnormal cardiac function observed in 43% of patients; irreversible congestive heart failure in 4%.
• Individual response to doxorubicin varied significantly, independent of dose or age.
• Cardiac dysfunction typically occurred within five months of doxorubicin cessation.
• Discontinuing doxorubicin in patients with SF < 20% improved function; digoxin offered no additional benefit.

Conclusions:

• Sequential echocardiographic evaluation is essential for monitoring cardiac function during and after doxorubicin therapy.
• Shortening fraction is a valuable tool for early detection of doxorubicin-induced cardiotoxicity.
• Prompt intervention, including drug cessation, can improve cardiac function in affected children.