Anthracycline-related cardiac dysfunction in pediatricmalignancies recognized by new modalities of echocardiography

Background: Cardiac changes due to anthracyclines were determined in 40 patients with childhood malignancy.Objectives: In this work, we aim to assess the cardiac status by clinical examination. ECG and echocardiography and estimate features of subclinical and clinical cardiotoxicity induced after conventional treatment with anthracyclines based chemotherapy.Patients and methods: Their ages ranged from 2-12 years. 20 were males and 20 were females. The patient data are collected from clinical examination, electrocardiographic, echocardiographic as well as routine investigation evaluation and results were tabularized and statistically analyzed. Clinical cardiac manifestations were absent except in two patients who had received the maximum cumulative dose of anthracyclines.Results: ECG finding was sinus tachycardia, supraventricular tachycardia, right BBB, decreased QRS voltage and QTc interval prolongation after receiving anthracycline containing chemotherapy especially in patients receiving high cumulative doses. Anaemia and fever considered an explanation for sinus tachycardia detected in newly diagnosed patients before receiving any chemotherapy. Echocardiography is accurate noninvasive method which is used in these studies by M-mode, 2D and 3D for measurement of EDD, EDV, ESD, ESV, EF, FS and stroke volume. Newly diagnosed patients before chemotherapy showed no echocardiographic abnormalities. After 6 months of receiving anthracycline measurements showed significant increase in ESD and ESV (p<0.05) and significant decrease in FS (p<0.05). Also, mean value of EF had been decreased to 52.38 ± 6.3% by 2D (p< 0.01) and to 52.9 ± 5.2% by 3D (p<0.01) and the mean of stroke volume was 31.83 ± 9.98 ml which is significantly lower than prechemotherapy (p<0.01). Also, mild to moderate mitral regurge was discovered in 2 of our patients.Conclusion: So in conclusion, our results showed that left ventricular contractility decreased slowly after anthracycline chemotherapy necessitating routine cardiac evaluation of newly diagnosed cases of childhood malignancy before any chemotherapy induction and also monitoring and follow up of cardiac structure and function periodically, along the course of chemotherapy using ECG and 3D echocardiography as an effective noninvasive method to detect early signs of cardiac toxicity.