Prospective longitudinal assessment of late anthracycline cardiotoxicity after childhood cancer: the role of diastolic function.

A nthracyclines are highly effective in the treatment of childhood malignancies, but are potentially cardiotoxic at all dose ranges. Early studies suggested that as many as 65% of acute lymphoblastic leukaemia (ALL) survivors have subclinical abnormalities of left ventricular (LV) systolic function at medium term follow up. More recent reports have shown that the prevalence of cardiac abnormalities is much lower with cumulative anthracycline doses of less than 250– 300 mg/m. It has been suggested that diastolic changes precede systolic dysfunction in various conditions and predict later deterioration. Similarly, LV restriction has been suggested to be a late functional event after anthracycline exposure. Most reports of anthracycline cardiotoxicity are cross-sectional studies of heterogeneous diagnostic groups receiving various anthracycline schedules. We obtained prospective longitudinal diastolic data in two well defined cohorts of long term survivors of ALL and Wilms’ tumor (WT) and compared this to systolic function. Both cohorts underwent echocardiographic evaluation in 1991–92 and again in 1995–96.