Exercise echocardiography in the detection of anthracycline cardiotoxicity

Abstract

Twenty long-term survivors of childhood cancer underwent exercise echocardiography to evaluate possible late anthracycline-induced cardiac toxicity. Ten patients ages 10 to 20 years had received anthracyclines, and ten patients ages 8 to 27 years had not received anthracyclines as part of their medical regimen. Both groups had normal cardiac function at rest. Patients who had not received anthracyclines had a greater increase in M-mode shortening fraction (P less than 0.005), velocity of circumferential fiber shortening (P = 0.05), and Doppler aortic peak flow velocity (P = 0.01) than patients receiving anthracyclines. There were no significant differences in work performed, or increase in heart rate or blood pressure with exercise between the groups. These results suggest that subtle abnormalities in myocardial function exist which become apparent only after exercise in survivors of childhood cancer who have received anthracyclines and have normal resting cardiac function.

Diagnosis of anthracycline-induced late cardiomyopathy by exercise-spiroergometry and stress-echocardiography

“…Both methods are complicated by the ability of the myocardium to compensate for early damage [23]. The sensitivity of echocardiography can be improved by exercise testing when failure of the FS and EF to increase in response to exercise may indicate myocardial damage.…”

Cardiovascular Complications of Cancer Therapy

“…94 Thus, measurements of diastolic function by Doppler echocardiography may be a sensitive method for early detection of toxicity. 94,95 Provocative testing with exercise 96 or dobutamine echocardiography 97 has also been used to assess early anthracycline cardiotoxicity. Thus, these provocative-testing modalities may be sensitive for the early detection of subclinical cardiomyopathy and may provide an opportunity for therapeutic intervention before the development of overt LV dysfunction.…”

Use of ICRF-187 for Prevention of Anthracycline Cardiotoxicity in Children: Preliminary Results

“…Endomycardial biopsy has been used in adults and in children receiving anthracycline chemotherapy, but it is too invasive a test for serial controls in childhood [20]. Previous studies have demonstrated the use of B and M mode echocardiography to show preclinical deterioration of cardiac function after chemotherapy or in longterm survivors of childhood cancer [4,21,221. At Bristol Royal Hospital for Sick Children regular monitoring of LV shortening fraction both before and during treatment was found to be useful [ 231.…”