Document Detail

Enalapril to prevent cardiac function decline in long-term survivors of pediatric cancer exposed to anthracyclines.
MedLine Citation:
PMID:  14990637     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To determine whether an angiotensin-converting enzyme (ACE) inhibitor, enalapril, prevents cardiac function deterioration (defined using maximal cardiac index [MCI] on exercise testing or increase in left ventricular end-systolic wall stress [LVESWS]) in long-term survivors of pediatric cancer. PATIENTS AND METHODS: This was a randomized, double-blind, controlled clinical trial comparing enalapril to placebo in 135 long-term survivors of pediatric cancer who had at least one cardiac abnormality identified at any time after anthracycline exposure. RESULTS: There was no difference in the rate of change in MCI per year between enalapril and placebo groups (0.30 v 0.18 L/min/m(2); P =.55). However, during the first year of treatment, the rate of change in LVESWS was greater in the enalapril group than in the placebo group (-8.59 v 1.85 g/cm(2); P =.033) and this difference was maintained over the study period, resulting in a 9% reduction in estimated LVESWS by year 5 in the enalapril group. Six of seven patients removed from random assignment to treatment because of cardiac deterioration were initially treated with placebo (P =.11), and one has died as a result of heart failure. Side effects from enalapril included dizziness or hypotension (22% v 3% in the placebo group; P =.0003) and fatigue (10% v 0%; P =.013). CONCLUSION: Enalapril treatment did not influence exercise performance, but did reduce LVESWS in the first year; this reduction was maintained over the study period. Any theoretical benefits of LVESWS reduction in this anthracycline-exposed population must be weighed against potential side effects from ACE inhibitors when making treatment decisions.
Jeffrey H Silber; Avital Cnaan; Bernard J Clark; Stephen M Paridon; Alvin J Chin; Jack Rychik; Alexa N Hogarty; Mitchell I Cohen; Gerald Barber; Monika Rutkowski; Thomas R Kimball; Cynthia Delaat; Laurel J Steinherz; Huaqing Zhao
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of clinical oncology : official journal of the American Society of Clinical Oncology     Volume:  22     ISSN:  0732-183X     ISO Abbreviation:  J. Clin. Oncol.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-01     Completed Date:  2004-03-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  820-8     Citation Subset:  IM    
Center for Outcomes Research, Children's Hospital of Philadelphia, 3535 Market St, Suite 1029, Philadelphia, PA 19104, USA.
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MeSH Terms
Anthracyclines / therapeutic use,  toxicity*
Child, Preschool
Disease Progression
Double-Blind Method
Enalapril / administration & dosage*
Exercise Test
Exercise Tolerance / drug effects
Follow-Up Studies
Heart Failure / chemically induced*,  drug therapy*,  physiopathology
Heart Function Tests / drug effects
Linear Models
Neoplasms / drug therapy*,  pathology
Reference Values
Risk Assessment
Severity of Illness Index
Treatment Outcome
Grant Support
Reg. No./Substance:
0/Anthracyclines; 75847-73-3/Enalapril

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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