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


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.


Anthracycline Cardiotoxicity Children Dexrazoxane 



body mass index


body surface area


cardiac index


cardiac output


dynamic stress echocardiography


ejection fraction


exercise tolerance


fractional shortening


left ventricle


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