Is screening for abnormal ECG patterns justified in long-term follow-up of childhood cancer survivors treated with anthracyclines?

Autor: Pourier MS; Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands., Mavinkurve-Groothuis AM; Princess Maxima Center of Pediatric Oncology, Utrecht, The Netherlands., Loonen J; Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands., Bökkerink JP; Department of Pediatric Hematology and Oncology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands., Roeleveld N; Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.; Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands., Beer G; Pediatric Cardiology Unit, Tel Aviv University, Tel-Aviv Sourasky Medical Centre, Tel Aviv, Israel., Bellersen L; Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands., Kapusta L; Pediatric Cardiology Unit, Tel Aviv University, Tel-Aviv Sourasky Medical Centre, Tel Aviv, Israel.; Children's Heart Centre, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2017 Mar; Vol. 64 (3). Date of Electronic Publication: 2016 Sep 21.
DOI: 10.1002/pbc.26243
Abstrakt: Background: ECG and echocardiography are noninvasive screening tools to detect subclinical cardiotoxicity in childhood cancer survivors (CCSs). Our aims were as follows: (1) assess the prevalence of abnormal ECG patterns, (2) determine the agreement between abnormal ECG patterns and echocardiographic abnormalities; and (3) determine whether ECG screening for subclinical cardiotoxicity in CCSs is justified.
Procedure: We retrospectively studied ECG and echocardiography in asymptomatic CCSs more than 5 years after anthracycline treatment. Exclusion criteria were abnormal ECG and/or echocardiogram at the start of therapy, incomplete follow-up data, clinical heart failure, cardiac medication, and congenital heart disease. ECG abnormalities were classified using the Minnesota Code. Level of agreement between ECG and echocardiography was calculated with Cohen kappa.
Results: We included 340 survivors with a mean follow-up of 14.5 years (range 5-32). ECG was abnormal in 73 survivors (21.5%), with ventricular conduction disorders, sinus bradycardia, and high-amplitude R waves being most common. Prolonged QTc (>0.45 msec) was found in two survivors, both with a cumulative anthracycline dose of 300 mg/m 2 or higher. Echocardiography showed abnormalities in 44 survivors (12.9%), mostly mild valvular abnormalities. The level of agreement between ECG and echocardiography was low (kappa 0.09). Male survivors more often had an abnormal ECG (corrected odds ratio: 3.00, 95% confidence interval: 1.68-5.37).
Conclusions: Abnormal ECG patterns were present in 21% of asymptomatic long-term CCSs. Lack of agreement between abnormal ECG patterns and echocardiographic abnormalities may suggest that ECG is valuable in long-term follow-up of CCSs. However, it is not clear whether these abnormal ECG patterns will be clinically relevant.
(© 2016 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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