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Long-term serial echocardiographic examination of late anthracycline cardiotoxicity and its prevention by dexrazoxane in paediatric patients

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Abstract

The authors conducted an 8-year prospective non-randomised study to determine whether dexrazoxane (ICRF-187) would reduce late anthracycline-induced cardiotoxicity in patients treated in childhood for haematological malignancy. The authors examined prospectively 75 patients (40 male/35 female) aged 2–17 years (median 6.5 years) at the time of diagnosis. The cardioprotection was given to 53 patients (26 male/17 female) and the standard protocol was used in 22 patients (14 male/8 female). The prospective echocardiographic evaluation was done before and after the chemotherapy and every year during the follow-up period. Dynamic stress echocardiography (DSE) was assessed in the final year. The clinical cardiotoxicity was not diagnosed. Higher cumulative doses of anthracycline were given in the dexrazoxane group (234±58 mg/m2, median 240 mg/m2 versus 203±86 mg/m2, median 210 mg/m2, P <0.04) and a significantly higher percentage of patients received cumulative doses >240 mg/m2 of anthracycline ( P <0.05). During the follow-up period, the fractional shortening (FS) declined in the no-dexrazoxane group only in the 8th year and was significantly lower compared to the dexrazoxane group ( P <0.05). The pathological decrease in FS was present in 24% of patients; 41% in the no-dexrazoxane and 17% in the dexrazoxane groups, respectively ( P <0.05). DSE demonstrated lower rest EF and cardiac index (CI) in the no-dexrazoxane group ( P <0.05); however, neither the response of EF and CI to the stress echocardiography nor the exercise tolerance significantly differed between sub-groups. A higher number of patients in the dexrazoxane group had very good exercise tolerance (ET) >3 Watts/kg ( P <0.05) and a lower number responded with a decreased ET <2 Watts/kg ( P <0.05) compared to the no-dexrazoxane group. Conclusion:Dexrazoxane seems to reduce the risk of late subclinical cardiotoxicity. Dexrazoxane-treated patients revealed better exercise tolerance; however the haemodynamic response to the stress was no different in both sub-groups.

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Abbreviations

BMI :

body mass index

BSA :

body surface area

CI :

cardiac index

CO :

cardiac output

DSE :

dynamic stress echocardiography

EF :

ejection fraction

ET :

exercise tolerance

FS :

fractional shortening

LV :

left ventricle

METs :

metabolic equivalents

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Acknowledgements

The study was supported by grant IGA from the Ministry of Health No. NR/8006-3 and partially by a grant from the Ministry of Education, Youth and Sports of the Czech Republic No. 002 162 2402.

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Authors and Affiliations

  1. Department of Cardiology, University Hospital Brno, Jihlavska 20, 62500 , Brno, Czech Republic

    Lubomir Elbl & Iva Tomaskova

  2. 1st Department of Paediatrics, University Hospital Brno, Brno, Czech Republic

    Hana Hrstkova & Jaroslav Michalek

  3. Department of Paediatrics, Faculty Hospital Ostrava, Ostrava, Czech Republic

    Bohumir Blazek

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  1. Lubomir Elbl
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  2. Hana Hrstkova
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Correspondence to Lubomir Elbl.

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Elbl, L., Hrstkova, H., Tomaskova, I. et al. Long-term serial echocardiographic examination of late anthracycline cardiotoxicity and its prevention by dexrazoxane in paediatric patients. Eur J Pediatr 164, 678–684 (2005). https://doi.org/10.1007/s00431-005-1732-x

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  • DOI: https://doi.org/10.1007/s00431-005-1732-x

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