Guidelines for Cardiac Monitoring of Children During and After Anthracycline Therapy: Report of the Cardiology Committee of the Childrens Cancer Study Group

Abstract

The anthracycline antibiotics, daunorubicin, doxorubicin, and the newer derivatives, are important components of many antineoplastic chemotherapeutic regimens. Their usefulness is limited by their cardiotoxicity. Sequential monitoring of cardiac function of patients undergoing chemotherapy allows identification of subclinical cardiotoxicity. In many patients monitoring can thus guide the modification of the chemotherapy to minimize cumulative cardiotoxicity, reducing acute and long-term clinical and subclinical sequelae. Such monitoring also aids in the comparison of cardiotoxicity produced by different drugs and different methods and schedules of drug administration. The considerable variability of monitoring regimens between institutions and in the literature has detracted from its usefulness. The Cardiology Committee of the Childrens Cancer Study Group has, therefore, reviewed the field and has formulated recommendations for standardized noninvasive monitoring of children during and immediately after chemotherapy and for the modification of the chemotherapy where indicated.

Pediatric Cardio-Oncology Medicine: A New Approach in Cardiovascular Care

“…The association of these drugs with cardiac dysfunction has influenced the establishment of regulatory policies for drug administration. Until the early 1990s, the Cardiology Committee of the Children’s Cancer Study Group formulated pediatric-specific recommendations for imaging monitoring of children undergoing chemotherapy [ 6 ]. Since then, there has been an upsurge of scientific statements and research venues to manage cardiotoxicity, including the incorporation of advanced imaging modalities, medications, and serum biomarkers for the stratification of cancer patients at risk of developing a cardiac illness.…”

“…Traditionally, cardiotoxicity is diagnosed via echo when there is (1) a 10% decrease in LV ejection fraction (LVEF), (2) an LVEF with an absolute value <55% and/or an abnormally low shortening fractioning (SF) [ 6 ]. Using LVEF as the sole marker of ventricular dysfunction is the suboptimal delineation of cardiac remodeling, a preclinical stage of myocardial injury, inflammation, and fibrosis leading to altered mass, geometry, and function of the heart [ 15 ].…”

Função sistólica do ventrículo esquerdo pela ecocardiografia em crianças e adolescentes com osteossarcoma tratados com doxorrubicina com e sem dexrazoxane

“…Valores maiores ou iguais a 30% são considerados normais. Disfunção sistólica do ventrículo esquerdo foi definida de acordo com o relatório do Comitê de Cardiologia do Grupo de Estudo de Crianças com Câncer dos Estados Unidos como PE igual ou inferior a 29%, e/ou diminuição da porcentagem de encurtamento, em valor absoluto, igual ou superior a 10 unidades do valor do exame realizado antes do início da quimioterapia de cada paciente 22,23 .…”

“…A porcentagem de encurtamento sistólico do ventrículo esquerdo é recomendada como índice para monitorização da função sistólica de pacientes em tratamento ou tratados com antraciclinas pelo Comitê de Cardiologia do Grupo de Estudo de Crianças com Câncer dos Estados Unidos 23 . De fato, vários estudos tomaram como base a fração de encurtamento e/ou a fração de ejeção para avaliar a função sistólica do ventrículo esquerdo, demonstrando a sua aplicabilidade 28,34,39 .…”

Cathepsin B Dependent Cleavage Product of Serum Amyloid A1 Identifies Patients with Chemotherapy-Related Cardiotoxicity

“…Monitoring of cardiac function is recommended to detect subclinical myocardial damage that may occur during or after chemotherapy but is expensive and time-intensive. , Most approaches used in clinical practice to assess cardiac function (e.g., echocardiographic evaluation of left ventricular ejection fraction (LVEF) or radionuclide ventriculography) have poor predictive power due to their low sensitivity to detect subclinical myocardial injury . Biomarkers of cardiac injury, including both troponin I (TnI) and the N-terminal pro-B-type natriuretic peptide (NT-proBNP), are promising diagnostic tools for early identification, assessment, and monitoring of cardiotoxicity.…”