Fm. Fink et al., CARDIAC TROPONIN-T AND CREATINE-KINASE MB MASS CONCENTRATIONS IN CHILDREN RECEIVING ANTHRACYCLINE CHEMOTHERAPY, Medical and pediatric oncology, 25(3), 1995, pp. 185-189
Anthracyclines (doxorubicin, daunorubicin, and derivatives) are among
the most effective antineoplastic drugs for pediatric cancer with dose
-limiting acute and longterm cardiotoxicity. The exact mechanism of th
e development of cardiomyopathy is still not clear. Anthracyclines may
induce subclinical acute myocardial injury leading to lysis of a limi
ted number of myocytes. Alternatively, myocytes may experience a trans
ient loss of cytoplasmic membrane integrity. Both conditions may lead
to a transient efflux of small amounts of cytoplasmic enzymes and othe
r proteins specific to the heart muscle fibers. To test these hypothes
es we assayed plasma creatine kinase (CK) MB mass and cardiac specific
troponin T (TnT). CKMB may be released even in case of reversible cel
l membrane injury, while prolonged elevation of TnT is the most sensit
ive and specific marker of limited myocardial necrosis. Thirty-five an
thracycline-containing chemotherapy courses in 22 children with cancer
were analyzed. CKMB mass and TnT concentrations were within the norma
l range in all children before anthracycline therapy. Within 72 hours
from anthracycline therapy no increment of one of these two marker pro
teins was detected (ANOVA for repeated measures, P = 0.94 [TnT] and 0.
25 [CKMB]). We conclude that only minimal if any acute necroses of car
diac myocytes occur after anthracycline therapy. Even membrane integri
ty appears to be maintained within the first 3 days after anthracyclin
e therapy, in the absence of electrocardiographic or echocardiographic
signs of acute cardiotoxicity. (C) 1995 Wiley-Liss, Inc.