Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-27T18:02:38.886Z Has data issue: false hasContentIssue false

Diastolic function in anthracycline-treated children

Published online by Cambridge University Press:  23 September 2014

Ashraf Harahsheh*
Affiliation:
Department of Pediatrics, Division of Cardiology, Children’s National Health System, The George Washington University School of Medicine, Washington, District of Columbia, United States of America
Sanjeev Aggarwal
Affiliation:
Department of Pediatrics, Division of Cardiology, Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
Michael D. Pettersen
Affiliation:
Rocky Mountain Pediatric Cardiology, Denver, Colorado, United States of America
Thomas L’Ecuyer
Affiliation:
Department of Pediatrics, Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, United States of America
*
Correspondence to: A. Harahsheh, MD, FACC, FAAP, Division of Cardiology, George Washington University, Center for Heart, Lung and Kidney Disease, Children’s National Health System, 111 Michigan Avenue, N.W. Washington, DC 20010, United States of America. Tel: +202 476 2020; Fax: +202 476 5700; Email: AHarahsh@childrensnational.org

Abstract

Background: Anthracyclines are effective medications for childhood cancer. Their limitation is the risk of cardiomyopathy. Although diastolic dysfunction has been described in patients who received anthracyclines, cardiac monitoring has focused on systolic function, which is abnormal in up to 41% of the patients. We conducted a study to assess diastolic function utilising transmitral inflow Doppler velocities and tissue Doppler imaging in anthracycline-treated children 5 years post-therapy. Methods: This was a retrospective study on 63 anthracycline-treated patients. Echocardiographic parameters included peak early and late transmitral inflow Doppler velocities (E, A), E/A ratio, E deceleration time, and tissue Doppler imaging early and late diastolic mitral annulus velocities (E′, A′), E/E′ ratio, and E′/A′ ratio. Results: All indices of diastolic function that we measured were normal in the anthracycline-treated patients. Conclusion: We conclude that diastolic function assessed by transmitral inflow Doppler velocities and tissue Doppler imaging is normal in anthracycline-treated children 5 years after completion of treatment. Further longitudinal study is needed to determine whether diastolic function becomes abnormal with time in this patient population.

Type
Original Articles
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Dr Harahsheh was a fellow at Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America at the time of conducting this study.

b

Drs Pettersen and L’Ecuyer were attending physicians at Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America at the time of conducting this study.

References

1. Fisher, B, Redmond, C, Wickerham, DL, et al. Doxorubicin-containing regimens for the treatment of stage ii breast cancer: the national surgical adjuvant breast and bowel project experience. J Clin Oncol 1989; 7: 572582.CrossRefGoogle ScholarPubMed
2. Shankar, SM, Marina, N, Hudson, MM, et al. Monitoring for cardiovascular disease in survivors of childhood cancer: report from the cardiovascular disease task force of the children’s oncology group. Pediatrics 2008; 121: e387e396.CrossRefGoogle ScholarPubMed
3. Gharib, MI, Burnett, AK. Chemotherapy-induced cardiotoxicity: current practice and prospects of prophylaxis. Eur J Heart Fail 2002; 4: 235242.CrossRefGoogle ScholarPubMed
4. Grenier, MA, Lipshultz, SE. Epidemiology of anthracycline cardiotoxicity in children and adults. Semin Oncol 1998; 25: 7285.Google ScholarPubMed
5. Karakurt, C, Kocak, G, Ozgen, U. Evaluation of the left ventricular function with tissue tracking and tissue doppler echocardiography in pediatric malignancy survivors after anthracycline therapy. Echocardiography 2008; 25: 880887.CrossRefGoogle ScholarPubMed
6. Lipshultz, SE, Colan, SD, Gelber, RD, Perez-Atayde, AR, Sallan, SE, Sanders, SP. Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med 1991; 324: 808815.CrossRefGoogle ScholarPubMed
7. Mulrooney, DA, Dover, DC, Li, S, et al. Twenty years of follow-up among survivors of childhood and young adult acute myeloid leukemia: a report from the childhood cancer survivor study. Cancer 2008; 112: 20712079.CrossRefGoogle Scholar
8. Singal, PK, Iliskovic, N. Doxorubicin-induced cardiomyopathy. N Engl J Med 1998; 339: 900905.CrossRefGoogle ScholarPubMed
9. Santin, JC, Deheinzelin, D, Junior, SP, Lopes, LF, de Camargo, B. Late echocardiography assessment of systolic and diastolic function of the left ventricle in pediatric cancer survivors after anthracycline therapy. J Pediatr Hematol Oncol 2007; 29: 761765.CrossRefGoogle ScholarPubMed
10. Lipshultz, SE. Exposure to anthracyclines during childhood causes cardiac injury. Semin Oncol 2006; 33: S8S14.CrossRefGoogle ScholarPubMed
11. Nagy, AC, Cserep, Z, Tolnay, E, Nagykalnai, T, Forster, T. Early diagnosis of chemotherapy-induced cardiomyopathy: a prospective tissue doppler imaging study. Pathol Oncol Res 2008; 14: 6977.CrossRefGoogle ScholarPubMed
12. Dorup, I, Levitt, G, Sullivan, I, Sorensen, K. Prospective longitudinal assessment of late anthracycline cardiotoxicity after childhood cancer: the role of diastolic function. Heart 2004; 90: 12141216.CrossRefGoogle ScholarPubMed
13. Redfield, MM, Jacobsen, SJ, Burnett, JC Jr., Mahoney, DW, Bailey, KR, Rodeheffer, RJ. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003; 289: 194202.Google ScholarPubMed
14. Stapleton, GE, Stapleton, SL, Martinez, A, et al. Evaluation of longitudinal ventricular function with tissue doppler echocardiography in children treated with anthracyclines. J Am Soc Echocardiogr 2007; 20: 492497.CrossRefGoogle ScholarPubMed
15. Kremer, LC, van Dalen, EC, Offringa, M, Ottenkamp, J, Voute, PA. Anthracycline-induced clinical heart failure in a cohort of 607 children: long-term follow-up study. J Clin Oncol 2001; 19: 191196.CrossRefGoogle Scholar
16. Aggarwal, S, Pettersen, MD, Bhambhani, K, Gurczynski, J, Thomas, R, L’Ecuyer, T. B-type natriuretic peptide as a marker for cardiac dysfunction in anthracycline-treated children. Pediatr Blood Cancer 2007; 49: 812816.CrossRefGoogle ScholarPubMed
17. Sohn, DW, Chai, IH, Lee, DJ, et al. Assessment of mitral annulus velocity by doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997; 30: 474480.CrossRefGoogle ScholarPubMed
18. Nagueh, SF, Appleton, CP, Gillebert, TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009; 10: 165193.CrossRefGoogle ScholarPubMed
19. Nagueh, SF, Appleton, CP, Gillebert, TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 2009; 22: 107133.CrossRefGoogle ScholarPubMed
20. Anderson, PA, Sleeper, LA, Mahony, L, et al. Contemporary outcomes after the fontan procedure: a pediatric heart network multicenter study. J Am Coll Cardiol 2008; 52: 8598.CrossRefGoogle ScholarPubMed
21. Eidem, BW, McMahon, CJ, Cohen, RR, et al. Impact of cardiac growth on doppler tissue imaging velocities: a study in healthy children. J Am Soc Echocardiogr 2004; 17: 212221.CrossRefGoogle ScholarPubMed
22. O'Leary, PW, Durongpisitkul, K, Cordes, TM, et al. Diastolic ventricular function in children: a doppler echocardiographic study establishing normal values and predictors of increased ventricular end-diastolic pressure. Mayo Clin Proc 1998; 73: 616628.CrossRefGoogle ScholarPubMed
23. Kantrowitz, NE, Bristow, MR. Cardiotoxicity of antitumor agents. Prog Cardiovasc Dis 1984; 27: 195200.CrossRefGoogle ScholarPubMed
24. Klein, AL, Burstow, DJ, Tajik, AJ, Zachariah, PK, Bailey, KR, Seward, JB. Effects of age on left ventricular dimensions and filling dynamics in 117 normal persons. Mayo Clin Proc 1994; 69: 212224.CrossRefGoogle ScholarPubMed
25. Rakowski, H, Appleton, C, Chan, KL, et al. Canadian consensus recommendations for the measurement and reporting of diastolic dysfunction by echocardiography: from the investigators of consensus on diastolic dysfunction by echocardiography. J Am Soc Echocardiogr 1996; 9: 736760.CrossRefGoogle ScholarPubMed
26. Rathe, M, Carlsen, NL, Oxhoj, H. Late cardiac effects of anthracycline containing therapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2007; 48: 663667.CrossRefGoogle ScholarPubMed
27. Roodpeyma, S, Moussavi, F, Kamali, Z. Late cardiotoxic effects of anthracycline chemotherapy in childhood malignancies. J Pak Med Assoc 2008; 58: 683687.Google ScholarPubMed
28. Ganame, J, Claus, P, Uyttebroeck, A, et al. Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patients. J Am Soc Echocardiogr 2007; 20: 13511358.CrossRefGoogle ScholarPubMed
29. Kocabas, A, Kardelen, F, Ertug, H, et al. Assessment of early-onset chronic progressive anthracycline cardiotoxicity in children: different response patterns of right and left ventricles. Pediatr Cardiol 2014; 35: 8288.CrossRefGoogle ScholarPubMed
30. Hashimoto, I, Li, X, Hejmadi Bhat, A, Jones, M, Zetts, AD, Sahn, DJ. Myocardial strain rate is a superior method for evaluation of left ventricular subendocardial function compared with tissue doppler imaging. J Am Coll Cardiol 2003; 42: 15741583.CrossRefGoogle ScholarPubMed
31. Arola, OJ, Saraste, A, Pulkki, K, Kallajoki, M, Parvinen, M, Voipio-Pulkki, LM. Acute doxorubicin cardiotoxicity involves cardiomyocyte apoptosis. Cancer Res 2000; 60: 17891792.Google ScholarPubMed
32. Moon, TJ, Miyamoto, SD, Younoszai, AK, Landeck, BF. Left ventricular strain and strain rates are decreased in children with normal fractional shortening after exposure to anthracycline chemotherapy. Cardiol Young, available on CJO2013. doi:10.1017/S1047951113001182.Google Scholar