EARLY DETECTION OF DOXORUBICIN AND DAUNORUBICIN CARDIOTOXICITY BY ECHOCARDIOGRAPHY - DIASTOLIC VERSUS SYSTOLIC PARAMETERS

Doxorubicin and daunorubicin are effective anticancer agents in childr en, however, their therapeutic value is limited by myocardial cardioto xicity. In 14 children (median age 5,0 years, range 3-12) prospective studies were performed using pulsed Doppler echocardiography to assess the changes in left ventricular systolic and diastolic filling dynami cs. None of these children developed cardiomyopathy. M-mode echocardio graphic systolic parameters and Doppler transmitral flow velocities we re analysed at baseline, after a cumulative anthracycline dose of 138 +/- 26 mg/m(2) (second examination) and after 240 +/- 15 mg/m(2) (thir d examination). At the second examination the acceleration time/ejecti on time ratio was significantly reduced (P < 0.01), but this was no lo nger evident at the third examination. There was no significant change of peak velocity over aortic valve, preejection period and change of velocity over time. In contrast, three diastolic parameters changed si gnificantly; the late over early inflow velocity (P < 0.05), mitral va lve late time velocity integral (P < 0.01 at the second and P < 0.05 a t the third examination) and the ratio A-TVI/ TVI (P < 0.025 and P < 0 .01). At the third examination the velocity of the A wave was also sig nificantly increased. Conclusion In anthracycline treated children lef t ventricular diastolic function deteriorates before systolic function . Diastolic function parameters should be used rather than systolic pa rameters to monitor these patients.