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Follow-up Study of Children with Anthracycline Cardiotoxicity

Journal of the Korean Pediatric Society 2003;46(3):242-249.
Published online March 15, 2003.
Follow-up Study of Children with Anthracycline Cardiotoxicity
Hyok Joo Kwon, Young Hwan Song, Soo Jung Kang, Hyoung Jin Kang, Hyoung Soo Choi, Eun Jung Bae, Hee Young Shin, Chung Il Noh, Yong Soo Yun, Hyo Seop Ahn
Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
소아 Anthracycline 심독성의 추적 관찰
권혁주, 송영환, 강수정, 강형진, 최형수, 배은정, 신희영, 노정일, 윤용수, 안효섭
서울대학교 의과대학 소아과학교실
Correspondence: 
Chung Il Noh, Email: chungnoh@plaza.snu.ac.kr
Abstract
Purpose
: We studied the relationship between anthracycline cumulative dose and anthracycline cardiotoxicity in childhood cancer and followed up 40 children with anthracycline cardiotoxicity.
Methods
: A retrospective study was performed in 154 children who received anthracycline chemotherapy between January 1995 to December 2000. Cardiotoxicity was defined when the left ventricular fractional shortening(FS) was below 26%; it was divided into two groups, mild and severe cardiotoxicity, according to the FS. We followed up survivors with cardiotoxicity, and checked their present cardiac function by physical activity, echocardiography, electrocardiography(EKG) and chest X-ray.
Results
: Of the 154 children treated with anthracyclines, forty(26.0%) were diagnosed as cardiotoxicity. The incidence of cardiotoxicity increased in exponential fashion with increases in the cumulative dose of anthracyclines. There was minimal increase of incidence until a dose of 300 mg/m2 after which the incidence increased rapidly. After mean 3.8?.8 year follow-up of 23 survivors with cardiotoxicity, FS increased significantly. EKG and chest X-rays were not helpful for the diagnosis of cardiotoxicity because of their low sensitivity and specificity.
Conclusion
: Although convenient, non-invasive and inexpensive, EKG and chest X-rays were not helpful for the follow-up of anthracycline cardiotoxicity. Almost all survivors with anthracycline cardiotoxicity have improved in both physical activity and echocardiographic findings after discontinuation of anthracyclines.
Key Words: Anthracycline, Cardiotoxicity, Fractional shortening, Echocardiography, Childhood cancer


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