Premium
Is screening for abnormal ECG patterns justified in long‐term follow‐up of childhood cancer survivors treated with anthracyclines?
Author(s) -
Pourier Milanthy S.,
MavinkurveGroothuis Annelies M. C.,
Loonen Jacqueline,
Bökkerink Jos P. M.,
Roeleveld Nel,
Beer Gil,
Bellersen Louise,
Kapusta Livia
Publication year - 2017
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.26243
Subject(s) - medicine , asymptomatic , cardiology , subclinical infection , cardiotoxicity , anthracycline , sinus bradycardia , electrocardiography , confidence interval , qt interval , signal averaged electrocardiogram , bradycardia , cancer , chemotherapy , breast cancer , heart rate , blood pressure
Abstract Background ECG and echocardiography are noninvasive screening tools to detect subclinical cardiotoxicity in childhood cancer survivors (CCSs). Our aims were as follows: (1) assess the prevalence of abnormal ECG patterns, (2) determine the agreement between abnormal ECG patterns and echocardiographic abnormalities; and (3) determine whether ECG screening for subclinical cardiotoxicity in CCSs is justified. Procedure We retrospectively studied ECG and echocardiography in asymptomatic CCSs more than 5 years after anthracycline treatment. Exclusion criteria were abnormal ECG and/or echocardiogram at the start of therapy, incomplete follow‐up data, clinical heart failure, cardiac medication, and congenital heart disease. ECG abnormalities were classified using the Minnesota Code. Level of agreement between ECG and echocardiography was calculated with Cohen kappa. Results We included 340 survivors with a mean follow‐up of 14.5 years (range 5–32). ECG was abnormal in 73 survivors (21.5%), with ventricular conduction disorders, sinus bradycardia, and high‐amplitude R waves being most common. Prolonged QTc (>0.45 msec) was found in two survivors, both with a cumulative anthracycline dose of 300 mg/m 2 or higher. Echocardiography showed abnormalities in 44 survivors (12.9%), mostly mild valvular abnormalities. The level of agreement between ECG and echocardiography was low (kappa 0.09). Male survivors more often had an abnormal ECG (corrected odds ratio: 3.00, 95% confidence interval: 1.68–5.37). Conclusions Abnormal ECG patterns were present in 21% of asymptomatic long‐term CCSs. Lack of agreement between abnormal ECG patterns and echocardiographic abnormalities may suggest that ECG is valuable in long‐term follow‐up of CCSs. However, it is not clear whether these abnormal ECG patterns will be clinically relevant.