EARLY DETECTION OF ANTHRACYCLINE CARDIOTOXICITY IN CHILDREN WITH ACUTE-LEUKEMIA USING EXERCISE-BASED ECHOCARDIOGRAPHY AND DOPPLER-ECHOCARDIOGRAPHY

We performed both supine bicycle ergometer (BEx) and hand-grip (HGx) e xercise tests to evaluate cardiac function in 13 asymptomatic children with leukemia who had completed a general treatment protocol. We calc ulated fractional shortening (FS), end-systolic stress-volume index (E SS/ESVI), left ventricular diastolic filling velocity ratio (A/E) and normalized peak rate of diastolic increase in left ventricular interna l dimension (dLVDt/dt/LVDt). Before the exercise, we found that dLVDt/ dt/LVDt was decreased in the high-dose anthracycline group (anthracycl ine cumulative dose of 480 - 570 mg/M2), even though other cardiac fun ction parameters were not different from those in the control. In BEx, the percent change in ESS/ESVI decreased in an anthracycline cumulati ve dose-dependent fashion. In HGx, ESS/ESVI showed a decreased respons e only in the high-dose anthracycline group. Therefore, we conclude th at: 1) the diastolic function parameter dLVDt/dt/LVDt might show abnor malities prior to other systolic function parameters, 2) the percent c hange in ESS/ESVI in BEx is the most sensitive parameter studied, and could detect cardiac function abnormalities even in the small-dose ant hracycline group (anthracycline cumulative dose of 175 mg/m2), and 3) BEx is more suitable for the early detection of anthracycline cardioto xicity than HGx.