Myocardial function in children and adolescents after therapy with anthracyclines and chest irradiation

Pihkala, Jaana; Saarinen, Ulla M.; Lundström, Ulla; Virtanen, Kari; Virkola, Kristina; Ma, Siimes; Pesonen, Erkki

doi:10.1016/0959-8049(95)00555-2

Cited by 83 publications

(37 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…179,180 Through the 1980s and 1990s, the number of case reports and case series describing clinically evident heart failure increased. [181][182][183][184] Overlapping with these reports were larger studies documenting a high frequency of echocardiographically defined systolic dysfunction in long-term survivors of childhood cancer treated with anthracyclines, particularly for ALL and Wilms tumor. 168,[185][186][187][188] These studies clearly documented that the risk of dysfunction was associated with the cumulative dose of anthracycline, younger age at diagnosis (particularly age <5 years), and time since diagnosis 164,167,186 and that no dose was without risk.…”

Section: Anthracyclinesmentioning

confidence: 99%

“…183,185,199,213 The most commonly used characteristics of LV systolic function with M-mode and 2-dimensional echocardiography-LV fractional shortening and LV ejection fraction 233 -are load dependent, have variable results, and do not evaluate regional myocardial function and therefore may not detect early stages (stage B by American College of Cardiology/American Heart Association (AHA) classification of heart failure) of LV dysfunction, which is one reason reports of anthracycline-related subclinical cardiotoxicity range from 0% to 57%. 200 Because asymptomatic LV systolic dysfunction in adults is associated with increased cardiovascular and all-cause mortality, 255,256 and because the late consequences of subclinical cardiac dysfunction in childhood survivors are not known, long-term serial cardiac monitoring should be considered.…”

Section: Anthracycline-induced Cardiomyopathymentioning

confidence: 99%

See 1 more Smart Citation

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

494

436

View full text Add to dashboard Cite

Section: Anthracyclinesmentioning

confidence: 99%

Section: Anthracycline-induced Cardiomyopathymentioning

confidence: 99%

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

494

436

View full text Add to dashboard Cite

“…Although the finding was not statistically significant, abnormally high LDL was more frequent in the anthracycline plus RT group than in the other treatment group. The extent to which this finding may reflect a cumulative effect between endothelial injury, the established synergism between RT and anthracycline in cardiotoxicity, 14,15 and alteration of fatty acid metabolism remains to be explored. White race significantly predicted a higher NYHA score; black race and a diagnosis of solid tumor predicted the lowest perceived general health scores.…”

Section: Discussionmentioning

confidence: 99%

Subclinical late cardiac toxicity in childhood cancer survivors

Cox

Shesh

Rosenthal

et al. 2008

Cancer

View full text Add to dashboard Cite

BACKGROUNDThe authors analyzed how self‐reported health and self‐reported modified New York Heart Association (NYHA) cardiac function scores were related to cardiac systolic function, cardiac risk factors, and cancer treatment history in childhood cancer survivors who reported no symptoms of cardiac disease.METHODSLong‐term survivors of pediatric cancer who were treated between 1971 and 1995 (current ages, 16–39.7 years) underwent noninvasive clinical and laboratory cardiac risk evaluation and responded to selected subscales of the Medical Outcomes Study 36‐item Short Form Health Survey. Results were compared with survivor history of anthracycline therapy alone or with radiotherapy (n = 127 patients; mean, 10 years after diagnosis) versus no anthracycline therapy (n = 32 patients; mean, 11 years after diagnosis).RESULTSSex, current age, highest school grade completed, race, age at diagnosis, diagnostic group, years off therapy, fractional shortening (FS), heart rate, and smoking status were found to be independently predictive of self‐reported health. Interaction between female sex and higher low‐density lipoprotein values and between diagnosis and abnormal FS variably predicted low reported vitality and low reported modified New York Heart Association (NYHA) scores. Echocardiographic findings, cardiac risk factors, and treatment history explained 13% to 28% of the variance in perceived health and self‐reported modified NYHA scores.CONCLUSIONSSystolic function and cardiac risk factors were linked to lower self‐reported health and NYHA scores even in the absence of clinically evident cardiotoxicity. Cancer 2008. ©2008 American Cancer Society.

show abstract

“…Long-term cardiac complications may occur several years after completion of anticancer treatment [1][2][3][4][5][6]. In the past year report from the Childhood Cancer Survivor Study (the largest cohort of childhood cancer survivors in the world) showed that survivors of childhood cancers are five to ten times more likely than their healthy siblings to develop heart disease even 30 years after diagnosis -such as congestive heart failure, myocardial infarction, pericardial disease, valvular heart disease [2].…”

mentioning

confidence: 99%

Long-term cardiac effects of treatment for childhood leukemia

Urbanová

Urbán²,

Šimková³

et al. 2010

neo

View full text Add to dashboard Cite

Late cardiac complications in cancer survivors may develop from subclinical myocardial damage. Biochemical correlates of minimal myocardial changes can be analyzed using a commercially available rapid assay. Biomarkers are considered more sensitive markers of subclinical cardiotoxicity than conventional electrocardiographic and echocardiographic methods.The aim of this study was to determine the values of plasma N-terminal pro brain natriuretic peptide (NT-pro-BNP) and cardiac troponin T (cTnT) in asymptomatic childhood leukemia survivors after anthracycline therapy in comparison with healthy volunteers. The survivors also underwent a detailed echocardiography.Twenty six survivors of leukemia previously treated with anthracyclines with total cumulative dose 95-600 (median 221) mg/m 2 were evaluated. Analyses of cTnT and NT-proBNP from blood samples and echocardiography were performed 5-25 years after completion of therapy for childhood leukemia. Control group for biochemical analyses consisted of 22 age-and gender-matched apparently healthy volunteers.Values of NT-proBNP were significantly elevated in ANT group compared to controls (35.1 ± 37.8 vs. 9.6 ± 6.7 pg/ml, P<0.010). CTnT remained below the diagnostic cut-off values in both groups. All echocardiographic parameters of patients remained normal.In conclusion, differences in NT-proBNP values between patients treated with anthracyclines and healthy volunteers might signal an initial stage of anthracycline-induced myocardial damage. The potential of this biomarker to detect subclinical anthracycline-induced myocardial alterations before development of echocardiographic and clinical changes is promising. Key words: cardiotoxicity, natriuretic peptides, cardiac troponins, anthracyclines, echocardiographyNeoplasma 57, 2, 2010 doi:10.4149/neo_2010_02_179Abbreviations: ANT group -patients previously treated with anthracyclines; cTn -cardiac troponins; cTnT -cardiac troponinT; NPs -natriuretic peptides; NT-proBNP -N-terminal fragment of the brain natriuretic peptide precursor; LV -left ventricular; LVEDD -left ventricular end-diastolic diameter; LVESD -left ventricular end-systolic diameter; LA -left atrium dimension; RV -right ventricular dimension; EF -ejection fraction; E -early diastolic flow velocity; A -late diastolic flow velocity; DT -deceleration time; IVRT -left ventricular isovolumetric relaxation time; TDI -tissue Doppler imaging; Ea -early diastolic velocity of the medial mitral annulus; Em; Sa -systolic velocity; Am -late diastolic velocity

show abstract

Myocardial function in children and adolescents after therapy with anthracyclines and chest irradiation

Cited by 83 publications

References 25 publications

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Subclinical late cardiac toxicity in childhood cancer survivors

Long-term cardiac effects of treatment for childhood leukemia

Contact Info

Product

Resources

About