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Serial Doppler Echocardiographic Evaluation of Anthracycline Induced Left Ventricular Dysfunction in Children

Journal of the Korean Pediatric Society 1993;36(2):214-222.
Published online February 15, 1993.
Serial Doppler Echocardiographic Evaluation of Anthracycline Induced Left Ventricular Dysfunction in Children
Nam Geun Heo, Myung Chul Hyun, Kun Soo Lee, Sang Bum Lee
Department of Pediatrics, School of Medicine, Kyungpook University, Taegu, Korea
Doppler심에코도를 이용한 Anthracycline에 의한 좌심실 기능 이상의 평가
허남근, 현명철, 이건수, 이상범
경북대학교 의과대학 소아과학교실
Abstract
Anthracycline drugs are chemoterapeutic agents highly effective against a wide range of neoplasms. However, its administration may be complicated by cardiotoxic reactions. There is a continuum of increasing risk with increasing total dose of drug rather than an absolute cutoff point for total dose drug of that should not be exceeded under any circumstances. At the present time it appears that a potentially important clinical application of Doppler echocardiography would be the noninvasive evaluation of global ventricular function. To assess the value of serial Doppler echocardiography in detecting early signs of anthracycline cardiotoxicity in children, we studied 50 patients (35 male and 15 female children, age range 1.6 to 20 years) admitted to the Department of Pediatrics in the Kyungpook National University Hospital for treatment of neoplasia between July 20, 1988 and April 20, 1991 prospectively. Eight three Doppler echocardiograms were performed prior to and at intervals after receiving varying doses of anthracycline and aortic velocity, acceleration time(AT), ejection time(ET), ratio at AT to ET(AT/ET), acceleration and velocity time integral, and mitral velocity of E and A waves and velocity time integral were measured. Pretreatment parameters were not differ from those of normal age matched control children. The aortic AT/ET showed significatn increase with increase in anthracycline dosage, being a mean (¡¾SD) of 0.30¡¾0.07 in the pretreatment group, 0.33(¡¾0.09) after 100mg/M2(p<0.01) but the mitral E/A peak velocity ratio showed significant decrease, being a mean (¡¾SD) of 1.47(¡¾0.26) in the pretreatment group and 1.36(¡¾0.09) after 400mg/M2(p<0.05). We could not relably ascertain the relationship between Doppler echocardiographic changes and development of anthracycline cardiomyopathy but these preliminary data show that Doppler echocar-diography may detect incremental changes in left ventricular function in anthracyclin cardiomyopathy. It is hoped that further study at higher dose levels in large populations for a sufficient follow up time will identify those patients with a risk of developing cardiomyopathy and then manage them appropriately.
Key Words: Doppler echocardiography, Anthracycline, Left ventricular dysfunction


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