Some Aspects of Early and Late Left Ventricular Myocardial Damage after Treatment with Anthracyclinesin Child Age

Overview

The use of anthracyclines in the treatment of malignities in children is restricted by their cardiotoxicity whichmay lead to dilated or restrictive cardiomyopathy.Early cardiotoxicity occurs at the age under one year after terminated treatment. The main cause is impairedcontractile ability of the left ventricle caused by damage or death of myocytes. Risk factors include the level of thecumulative dose, the level of individual bolus doses, female sex, black race, amsacrin administration and trisomyon the 21st chromosome.Late cardiotoxicity occurs during the period longer than one year after completed treatment. It develops asa result of an excessive afterload while the ventricular wall is thinner and the contractility is impaired.Animportantrisk factor is young age of the child at the time when chemotherapy was administered and the interval aftercompleted treatment.The reported incidence of cardiotoxicity is 1 - 2 %, clinical signs of late cardiotoxicity during the first decadeafter chemotherapy are described in 5 - 10%.Although anthracycline treatment significantly improved survival of patients treated in childhood on accountof a malignity, cardiac complications must be foreseen in future. This pertains in particular to patients who weretreated years ago with high cumulative anthracycline doses. To what extent late cardiotoxicity will influence thesurvival of oncological patients in the second and third decade after chemotherapy will be revealed by long-termprospective studies.

Key words:
anthracyclines, cardiotoxicity, risk factors