Myocardial function and postmortem myocardial histology in children given anthracycline therapy for cancer

In an autopsy series of children with cancer, histopathologic myocardial changes caused by anthracyclines (A) were evaluated. The series comprised three groups: group A, 9 patients given A whose myocardial function had been evaluated before death; group B, 10 patients given A, but no lifetime echocardiographic evaluation; group C, 8 patients treated with chemotherapy regimens not including A. Both the cumulative A dose (P < 0.01) and the age of the patient at death (P < 0.001) were correlated with the pathologic changes in the myocardium. In echocardiography of group A patients, left ventricular (LV) contractility was subnormal in 5 (56%) patients, and the afterload was elevated in 3 (33%); the morphologic changes correlated with the LV wall stress (= afterload) (P < 0.05) and with LV fractional shortening (P < 0.04). We conclude that clinical decisions about A therapy should be based on cumulative A dose and myocardial function tests. Myocardial biopsies should be restricted to selected cases.