Myocardial impairment in children treated for cancer - Tips from Other Journals

Date: Sept, 1991

Anthracycline drugs, especially doxorubicin, are widely used in the treatment of cancer in children. However, the dosage is limited because of substantial cardiac toxicity. The incidence of cardiac failure is about 30 percent in children receiving more than 550 mg per [m.sup.2], compared with less than 0.3 percent in children receiving less than 550 mg per [m.sup.2]. Yeung and colleagues evaluated the use of an exercise-based technique to detect myocardial damage in apparently normal children who had received anthracycline drugs in the treatment of cancer.

The study included 19 children who had received anthracyclines and 10 children who had received other cytotoxic drugs in the treatment of cancer. The children were all over six years of age, and their cancer was in remission. These children appeared to have normal cardiac function at rest. Measurements of left ventricular dimensions on echocardiography, heart rate and blood pressure were recorded at rest and after exercise on a stationary bicycle for up to 10 minutes.

No differences were found between the two groups of children in results of resting echocardiography or in heart rate and blood pressure measurements after exercise. Significant differences were found between the two groups in echocardiographic changes after exercise. This difference remained significant after adjustment for age and drug exposure.

The authors conclude that children who have received anthracyclines and have normal myocardial function at rest may have impaired myocardial response to the physiologic stress of exercise. Echocardiography after exercise appears to be an effective noninvasive method in the detection of myocardial damage. Long-term cardiologic surveillance may be necessary in these children. (Lancet, April 6, 1991, vol. 337, p.816.)

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