European Journal of Pediatrics

, Volume 164, Issue 11, pp 678–684

Long-term serial echocardiographic examination of late anthracycline cardiotoxicity and its prevention by dexrazoxane in paediatric patients

  • Lubomir Elbl
  • Hana Hrstkova
  • Iva Tomaskova
  • Bohumir Blazek
  • Jaroslav Michalek
Original Paper

DOI: 10.1007/s00431-005-1732-x

Cite this article as:
Elbl, L., Hrstkova, H., Tomaskova, I. et al. Eur J Pediatr (2005) 164: 678. doi:10.1007/s00431-005-1732-x

Abstract

The authors conducted an 8-year prospective non-randomised study to determine whether dexrazoxane (ICRF-187) would reduce late anthracycline-induced cardiotoxicity in patients treated in childhood for haematological malignancy. The authors examined prospectively 75 patients (40 male/35 female) aged 2–17 years (median 6.5 years) at the time of diagnosis. The cardioprotection was given to 53 patients (26 male/17 female) and the standard protocol was used in 22 patients (14 male/8 female). The prospective echocardiographic evaluation was done before and after the chemotherapy and every year during the follow-up period. Dynamic stress echocardiography (DSE) was assessed in the final year. The clinical cardiotoxicity was not diagnosed. Higher cumulative doses of anthracycline were given in the dexrazoxane group (234±58 mg/m2, median 240 mg/m2 versus 203±86 mg/m2, median 210 mg/m2, P <0.04) and a significantly higher percentage of patients received cumulative doses >240 mg/m2 of anthracycline ( P <0.05). During the follow-up period, the fractional shortening (FS) declined in the no-dexrazoxane group only in the 8th year and was significantly lower compared to the dexrazoxane group ( P <0.05). The pathological decrease in FS was present in 24% of patients; 41% in the no-dexrazoxane and 17% in the dexrazoxane groups, respectively ( P <0.05). DSE demonstrated lower rest EF and cardiac index (CI) in the no-dexrazoxane group ( P <0.05); however, neither the response of EF and CI to the stress echocardiography nor the exercise tolerance significantly differed between sub-groups. A higher number of patients in the dexrazoxane group had very good exercise tolerance (ET) >3 Watts/kg ( P <0.05) and a lower number responded with a decreased ET <2 Watts/kg ( P <0.05) compared to the no-dexrazoxane group. Conclusion:Dexrazoxane seems to reduce the risk of late subclinical cardiotoxicity. Dexrazoxane-treated patients revealed better exercise tolerance; however the haemodynamic response to the stress was no different in both sub-groups.

Keywords

Anthracycline Cardiotoxicity Children Dexrazoxane 

Abbreviations

BMI

body mass index

BSA

body surface area

CI

cardiac index

CO

cardiac output

DSE

dynamic stress echocardiography

EF

ejection fraction

ET

exercise tolerance

FS

fractional shortening

LV

left ventricle

METs

metabolic equivalents

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Lubomir Elbl
    • 1
  • Hana Hrstkova
    • 2
  • Iva Tomaskova
    • 1
  • Bohumir Blazek
    • 3
  • Jaroslav Michalek
    • 2
  1. 1.Department of CardiologyUniversity Hospital BrnoBrno Czech Republic
  2. 2.1st Department of PaediatricsUniversity Hospital BrnoBrno Czech Republic
  3. 3.Department of PaediatricsFaculty Hospital OstravaOstrava Czech Republic