Document Detail

The evaluation of left ventricular function in childhood cancer survivors by pharmacological stress echocardiography.
MedLine Citation:
PMID:  12937852     Owner:  NLM     Status:  MEDLINE    
Late cardiotoxicity after anthracycline chemotherapy for childhood cancer is well recognized sequelae. Many long-term survivors may have subclinical cardiac dysfunction undetectable at a baseline evaluation. Various tests have been utilized for the diagnosis of left ventricular impairment. Recently, low-dose dobutamine stress echocardiography has been proposed as a more sensitive screening test. We have applied low-dose dobutamine stress echocardiography (5-10 microg/kg/min) in 36 asymptomatic survivors (20 male/16 female aged 14.6+/-4.7 years) treated with a cumulative dose of 226+/-106 mg/m2 of doxorubicin. The median follow-up was 5 years. Control group consisted of 20 sex and age matched volunteers (12 male/8 female aged 12.6+/-4.9 years). We found significant differences in mean velocity of circumferential fibre shortening, myocardial performance index (Tei index), left ventricular posterior wall thickening and endsystolic wall stress at a baseline. The stress response was significantly blunted only in a patient group in the following parameters: endsystolic wall stress, isovolumic relaxation time and myocardial performance index. The threshold response was abnormal (0-5% improvement of a variable only) in 45% of subjects from a control group in one or two parameters. On the contrary, 63% of subjects from a patient group responded pathologically (the worsening of a variable) in one or more parameters. We have not found a good correlation between risk factors of late cardiotoxicity and stress changes of left ventricular function parameters. Low-dose dobutamine stress echocardiography is safe and feasible diagnostic tool in children and adolescents. Dobutamine significantly increases the differences in cardiac variables between healthy population and asymptomatic survivors for childhood cancer. In comparison to the controls, most asymptomatic patients revealed subclinical myocardial damage at test. The predictive value for the development of clinical symptoms and cardiac complications need to be assessed in a large prospective study.
L Elbl; H Hrstkova; V Chaloupka; J Novotny; J Michalek
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neoplasma     Volume:  50     ISSN:  0028-2685     ISO Abbreviation:  Neoplasma     Publication Date:  2003  
Date Detail:
Created Date:  2003-08-25     Completed Date:  2003-09-12     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0377266     Medline TA:  Neoplasma     Country:  Slovakia    
Other Details:
Languages:  eng     Pagination:  191-7     Citation Subset:  IM    
Department of Cardiopulmonary Testing, Faculty Hospital Brno, 639 00 Brno, Czech Republic.
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MeSH Terms
Antibiotics, Antineoplastic / adverse effects,  therapeutic use
Cardiotonic Agents / diagnostic use*
Case-Control Studies
Dobutamine / diagnostic use*
Doxorubicin / adverse effects,  therapeutic use
Echocardiography, Stress / methods*
Follow-Up Studies
Neoplasms / drug therapy*
Sensitivity and Specificity
Ventricular Dysfunction, Left / chemically induced,  diagnosis*
Ventricular Function, Left
Reg. No./Substance:
0/Antibiotics, Antineoplastic; 0/Cardiotonic Agents; 23214-92-8/Doxorubicin; 34368-04-2/Dobutamine

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

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