LATE ECHOCARDIOGRAPHIC FINDINGS FOLLOWING CHILDHOOD CHEMOTHERAPY WITHNORMAL SERIAL CARDIAC MONITORING

Purpose: Late development of myocardial dysfunction years following su ccessful treatment of childhood malignancy with anthracyclines is well documented. There have been few studies of late cardiac performance i n children in whom serial monitoring during treatment suggested normal cardiac performance, and those studies that do exist rely on the resu lts of extensive evaluation. It was our purpose to determine whether f indings consistent with known late cardiac changes could be discovered in these patients by echocardiographic monitoring similar to that rou tinely performed during treatment. Patients and Methods: A total 28 co nsecutive asymptomatic patients who had completed anthracycline therap y at least 3 years previously, had been free of malignant disease sinc e the completion of therapy, and who had had normal serial echocardiog raphic studies during and at completion of treatment were restudied by echocardiography. Of these 28, 12 had undergone mediastinal radiation as part of their acute treatment. Results: Four patients (14%) of the study group were found to have abnormally low values for left ventric ular shortening and ejection fractions. All four had also received med iastinal radiation. The remaining 24 patients, while having values for shortening fraction within the normal range, had, as a group, experie nced a significant decrease in echocardiographic left ventricular shor tening since completion of treatment. In these patients, left ventricu lar wall thickness had not increased commensurate with growth in body size and left ventricular cavity dimension. Conclusions: The known inc idence of late asymptomatic cardiac dysfunction is confirmed despite t he presence of persistently normal echocardiographic monitoring studie s during and at completion of anthracycline treatment. Additionally, a s a population, these patients show impaired myocardial growth over ti me, placing them at risk for future myocardial failure. Normal echocar diographic monitoring studies during antineoplastic treatment in child ren may not necessarily predict that patients will be free of the deve lopment of late cardiac dysfunction. Routine serial echocardiographic monitoring can, however, be helpful in the long-term management of the se patients.