Anthracycline treatment in children with acute lymphoblastic leukemia significantly decreased heart rate variability and altered the LF/HF ratio (p=0.035) compared to baseline.
Cohort (n=35)
Does anthracycline treatment reduce heart rate variability in pediatric patients with acute lymphoblastic leukemia?
Anthracycline treatment in children with acute lymphoblastic leukemia significantly reduces heart rate variability before reaching the total cumulative dose, suggesting HRV monitoring via Holter ECG could serve as an early indicator of subclinical cardiotoxicity.
p-value: p=0.035
Anthracycline treatments are known to cause cardiotoxic long-term side effects in cancer survivors. Recently, a decrease in heart rate variability (HRV) has been identified in these patients, signaling autonomic dysfunction and altered cardiac fitness. This study aimed at evaluating changes in HRV in children treated with anthracyclines. A total of 35 pediatric patients with acute lymphoblastic leukemia were evaluated by means of a 24 h Holter ECG, at baseline and after reaching half the total cumulative dose of doxorubicin equivalent (120 mg/m2). Parameters of HRV were assessed, as well as any arrhythmic episodes, bradycardia and tachycardia percentages. The results showed a significant decrease in both time-domain and frequency-domain HRV parameters, following anthracycline treatment. The low-frequency (LF) to high-frequency (HF) parameters’ ratio also displayed a significant difference (p = 0.035), suggestive of early cardiac autonomic dysfunction. Of note, none of the patients presented symptoms of heart disease or elevated troponins, and only two patients presented echocardiographic signs of diastolic dysfunction. The present study showed that cardiac autonomic nervous system regulation is compromised in children treated with anthracyclines even before reaching the total cumulative dose. Therefore, HRV parameters could be the first indicators of subclinical cardiac toxicity, making Holter ECG monitoring of the oncological patient a necessity.
Lazar et al. (Sun,) conducted a cohort in Acute lymphoblastic leukemia (n=35). Anthracyclines vs. Baseline was evaluated on Low-frequency (LF) to high-frequency (HF) parameters' ratio (p=0.035). Anthracycline treatment in children with acute lymphoblastic leukemia significantly decreased heart rate variability and altered the LF/HF ratio (p=0.035) compared to baseline.
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