Why the study?
Do histopathologic myocardial changes correlate with cumulative anthracycline dose and echocardiographic findings in children with cancer?
Do histopathologic myocardial changes correlate with cumulative anthracycline dose and echocardiographic findings in children with cancer?
In children with cancer, anthracycline-induced histopathologic myocardial changes correlate with cumulative dose and echocardiographic parameters, suggesting clinical decisions can rely on non-invasive tests rather than routine myocardial biopsies.
Myocardial histopathology associations in pediatric anthracycline exposure remain hypothesis-generating; does not support replacing biopsy with echo monitoring.
In an autopsy series of children with cancer, histopathologic myocardial changes caused by anthracyclines (A) were evaluated. The series comprised three groups: group A, 9 patients given A whose myocardial function had been evaluated before death; group B, 10 patients given A, but no lifetime echocardiographic evaluation; group C, 8 patients treated with chemotherapy regimens not including A. Both the cumulative A dose (P < 0.01) and the age of the patient at death (P < 0.001) were correlated with the pathologic changes in the myocardium. In echocardiography of group A patients, left ventricular (LV) contractility was subnormal in 5 (56%) patients, and the afterload was elevated in 3 (33%); the morphologic changes correlated with the LV wall stress (= afterload) (P < 0.05) and with LV fractional shortening (P < 0.04). We conclude that clinical decisions about A therapy should be based on cumulative A dose and myocardial function tests. Myocardial biopsies should be restricted to selected cases.
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Pihkala et al. (1994) studied this question.
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