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Exercise echocardiography reveals subclinical cardiac dysfunction in young adult survivors of childhood acute lymphoblastic leukemia
Author(s) -
Jarfelt M.,
Kujacic V.,
Holmgren D.,
Bjarnason R.,
Lannering B.
Publication year - 2007
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.21289
Subject(s) - medicine , asymptomatic , ejection fraction , subclinical infection , cardiology , cardiac function curve , cardiotoxicity , heart failure , chemotherapy
Objective Anthracyclines (AC) have contributed significantly to increased survival rate in acute lymphoblastic leukemia (ALL), although the use of these drugs is limited due to cardiotoxicity. The aim was to evaluate heart muscle function in asymptomatic adult survivors of ALL treated in early childhood in relation to the combined effects of AC and other potential cardiotoxic factors. Procedure Twenty‐three young adult ALL survivors who had all received treatment with median 120 (120–400) mg AC/m 2 before the onset of puberty were examined median 21 years after remission and compared with 12 healthy controls. Basal echocardiography including two‐dimensional (2D) M‐mode and Doppler examination was performed, followed by a maximal exercise stress test and stress echocardiography immediately after stress test and after 5 min recovery. Results We found significant differences in systolic function between patients and controls at maximal exercise despite absence of reported symptoms from the patients. The most marked difference was in ejection fraction at stress 59.5% (32.6–81.1) and 77.3% (66.2–85.3), respectively ( P < 0.00006). Ten out of 23 patients reduced their ejection fraction at stress compared with at rest; this was not found in any of the controls. Cardiovascular risk factors such as GH deficiency and a high proportion of trunk fat did not have an impact on cardiac function. Conclusions With very long follow up in a homogenous cohort of ALL survivors, we found subclinical cardiac dysfunction with exercise stress echocardiography even after low doses of AC. Pediatr Blood Cancer 2007;49:835–840. © 2007 Wiley‐Liss, Inc.