Cardiotoxicity of the anthracyclines used in therapy of childhood cancer justify the attention granted from speciality literature for precocious diagnosis of these phenomenons and for monitoring, in order to reduce this new cardiovascular risk factor and hence, to improve the prognosis of main disease.
Early detection of cardiotoxicity chemotherapy by specific biomarkers: cTnI (cardiac troponin I) and BNP (B-type natriuretic peptide) and to establish IECA efficacity in treatment of anthracycline-induced cardiotoxicity.
27 patients (3 — 18 years old), from Department of Pediatric Hemato-Oncology, Iasi, Romania ; Patient evaluation: history and physical ; electrocardiogram ; chest X-ray, 2D/Doppler echocardiography, cardiac biomarkers — BNP,cTnI and cardiac enzymes: ASAT,ALAT,CPK. Patientswere divided into 3 groups(A,B,C): A- 11 new cases of childhood cancer ; B — 10 children on treatment with enalapril for cardioprotection ; C- 6 children with chemotherapeutic protocol completed, without cardioprotector treatement. Interval between assessments was set differently depending on the subgroup studied.
Clinical manifestations: heart failure (1 case), untypical clinic manifestation(mild dyspnea, fatigue, asthenia, palpitations)-15 cases ; echocardiography — suggestive modifications for cardiotoxicity:6 cases(22,2 %): diastolic dysfunction of the left ventricle(LV)- 5cases, systolic dysfunction LV- 1case ; electrocardiographycal changes: insignificant (sinusal tachycardia, minor ventricular repolarization impairement of LV). High values of plasma BNP (cutt-off value — 100pg/ml) were highlighted in 11 patients (4 patients with values between 100-200 pg/ml and 7 >200pg/ml. cTnI values obtained: all cases was situated under the cutt-off value of 0.4 ng/mL. Increased values of plasma BNP was directly correlated with dose administred of antracicline and chemotherapeutic protocol followed. All children on cardioprotector treatment had normal values of BNP and cTnI. Any changes of ASAT, ALAT, CPK weren’t correlated with changes obtained in determining the BNP and cTnI.
The results obtained are useful to establish a new program and best long-term screening, surveillance, prevention and treatment of malignancies in survivors of childhood. Obtaining data from this study confirmed the results published by the references studies of a major importance authors, claiming the correctness of the method and protocol for monitoring patients in the presented study.
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